Elevated fibrin‐related and fibrinogen‐related antigens in patients with liver disease

Patients with liver disease have a variety of coagulation abnormalities. These derangements are of uncertain origin and do not always correlate with disease severity or activity. We have measured the levels and proportions of the total fibrin‐related and fibrinogenrelated antigens, the principal fibrin (D‐dimer) and fibrinogen (D‐monomer) degradation fragments and intermediates of fibrin formation (fibrin monomers) in patients with a variety of acute and chronic liver diseases in whom all known other precipitating causes of disseminated intravascular coagulation had been excluded. Fibrin‐related and fibrinogen‐related antigens were extracted from serum using antihuman fibrinogen‐IgG covalently bound to activated aminophenylthioether paper disks and were subjected to 4% to 11% sodium dodecyl sulfate—polyacrylamide gel electrophoresis under nonreducing conditions. Fibrinrelated and fibrinogen‐related antigen proportions were determined by densitometry, and their levels were measured by radioimmunoassay. Levels of total fibrin‐related and fibrinogen‐related antigens (and D‐dimer) were significantly elevated (p < 0.01) in patients with cirrhosis (121 to 641 ng/ml) and hepatocellular carcinoma (416 to 8,786 ng/ml) when compared with patients with acute viral hepatitis (84 to 322 ng/ml) and control subjects (38 to 186 ng/ml). In addition, D‐monomer levels were elevated. These findings strongly suggest that disseminated intravascular coagulation is a component of the coagulopathy of certain liver diseases. Because fibrin‐related and fibrinogen‐related antigens have anticoagulant, vasoactive and immunosuppressive properties, their elevated presence may be biologically significant in these patients. (HEPATOLOGY 1992;16:920–923.) Copyright © 1992 American Association for the Study of Liver Diseases