Correlation between both Child Pugh Score and Spontaneous Bacterial Peritonitis with Plasma D-Dimer Level in Cirrhotic Patients

Abstract

Background: Cirrhosis is a chronic liver disease in which diffuse destruction and regeneration of hepatic parenchymal cells have occurred. D-dimer is regarded as a diagnostic marker for Portal vein thrombosis in liver cirrhosis. Objective: To correlate plasma D-dimer levels as a hemostatic parameter with Child Turcotte Pugh (CTP) score of post hepatitis cirrhosis patients and occurrence of spontaneous bacterial peritonitis (SBP). Patients and methods: This was a case-control study that included 84 patients with hepatitis C-related cirrhosis who were admitted to Al-Ahrar Teaching Hospital in the period from November 2020 to June 2021. 28 apparently healthy subjects were included as control group.Results: There was a significantly higher level of D-dimer in each cirrhotic group; child A, child B and child C with median of 1.05 mg/l, 2 mg/l and 3 mg/l respectively compared to healthy control group with a median of 0.09 mg/l. The best cutoff of D dimer in prediction of Child C was ≥ 2.45 mg/l with area under curve of 0.986, sensitivity of 96.4%, specificity of 94%, positive predictive value (PPV) of 84.4%, negative predictive value of 98.8 % and accuracy of 94.6% (p < 0.001). There was a statistically significant association between SBP and D dimer, which was significantly higher among those with SBP. Conclusion: D-dimer was correlated with esophageal varices grades and degree of ascites. D-dimer could be a marker for severity of liver disease in patients with post hepatitis c cirrhosis as indicated by Child' score.