Alterations in Primary Haemostasis in Patients With Liver Cirrhosis and Bacterial Infection

ABSTRACT Background/Aims There is a controversy regarding hyporesponsiveness of platelet (PLT) aggregation in liver cirrhosis (LC). This study aimed to assess alterations in PLT aggregation and von Willebrand factor (vWF)‐related parameters, as well as their prognostic role in bacterial infection (BI) superimposed on LC. Methods PLT aggregation was assessed using thromboelastography PLT mapping assay. v WF antigen (vWF:Ag), vWF Ristocetin cofactor (vWF:RCo) and FVIII levels were also measured in patients with decompensated cirrhosis and BI (DC + BI), stable decompensated cirrhosis (SDC) and infection without LC (control group). The prognostic value of PLT aggregation was evaluated only in the DC + BI group. Results Seventy‐one patients were enrolled in the DC + BI, 38 in the SDC and 20 in the control group. Patients with DC + BI had significantly reduced PLT aggregation in response to adenosine diphosphate (ADP) compared with those with SDC ( p = 0.042). Elevated vWF:Ag, vWF:RCo and FVIII levels accompanied impaired PLT aggregation (ADP) ( p = 0.002, p = 0.003 and p = 0.042, respectively). Within the DC + BI group, patients with organ failure exhibited lower PLT aggregation (ADP) . In survival analysis of the DC + BI group, non‐survivors demonstrated reduced ADP‐induced PLT aggregation, which showed high accuracy in predicting mortality (AUROC = 0.851). In a multivariate cox regression model including age, gender, MELD score and PLT aggregation (ADP) , age ( p = 0.048), gender ( p = 0.023) and PLT aggregation (ADP) ( p < 0.001) were independently associated with 30‐day mortality. Conclusions ADP‐induced PLT aggregation is impaired in DC with infection in a stepwise manner according to infection severity and has prognostic implications, as it is associated with 30‐day mortality. Elevated vWF:Ag, vWF:RCo and FVIII levels accompany PLT hyporesponsiveness.