Identifying a Novel Biomarker to Determine Clotting Risk in Patients with Cirrhosis
AAPA ePoster library. Hass V. 05/17/17; 180516; 144
Virginia Hass
Virginia Hass
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Abstract
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Purpose: Patients who have liver cirrhosis frequently develop elevated International Normalized Ratio (INR) and, quite surprisingly, blood clots. Therefore, one cannot use INR to accurately assess clotting risk in this patient population. The purpose of this study was to identify a novel biomarker that could be used to determine the clotting risk in patients who have a diagnosis of liver cirrhosis. Methodology: This is a retrospective study involving 514 adult patients who had liver cirrhosis with elevated INR greater than 1.3. Laboratory results of these patients from January 1, 2010 through December 31, 2015 were extracted from electronic medical records (EMR) at one academic medical center. The extracted data (Platelets, INR, and Albumin levels) of patients who had cirrhosis as well as clotting diagnoses were compared with the data from patients with cirrhosis who had no clotting episodes. The data from these two patient populations were plotted and analyzed for correlation. Results: There were 5,513 lab entries extracted from 514 patients during the specified time frame, of which 1,288 entries were from 48 patients who had both cirrhosis and at least one documented clotting episode. The mean ratio of albumin to platelets for the patients with cirrhosis and who developed clots was 0.036 (±0.033) whereas the ratio of albumin to platelets for the patients with cirrhosis but no clots was 0.034 (±0.028). Meanwhile, the mean ratios of INR to platelets for patients who had clots were 0.023 (±0.025) and for patients who had no-clots were 0.023 (±0.020). When the ratios of albumin to platelets were plotted against the ratios of INR to platelets, the data follow a linear relationship. The trend line equation for the population with clots was determined to be at Y = 0.6195x + 0.0007 (R2 = 0.6737), while the patient population who had no-clots was Y= 0.5184x + 0.0056 (R2 = 0.5425). When the two graphs were superimposed, the two lines separated at the level where the ratio of INR to platelet exceeded 0.05. Conclusions: The ratio of INR to platelets may be used to determine the clotting risk in patients with cirrhosis. The study revealed that cirrhotic patients who developed clots have a unique relationship within the three commonly drawn labs: albumin, INR, and platelets. The graphs of the ratios of albumin to platelets and INR to platelets were observed to follow a linear relationship among the two populations - patients who have clots vs. ...
Purpose: Patients who have liver cirrhosis frequently develop elevated International Normalized Ratio (INR) and, quite surprisingly, blood clots. Therefore, one cannot use INR to accurately assess clotting risk in this patient population. The purpose of this study was to identify a novel biomarker that could be used to determine the clotting risk in patients who have a diagnosis of liver cirrhosis. Methodology: This is a retrospective study involving 514 adult patients who had liver cirrhosis with elevated INR greater than 1.3. Laboratory results of these patients from January 1, 2010 through December 31, 2015 were extracted from electronic medical records (EMR) at one academic medical center. The extracted data (Platelets, INR, and Albumin levels) of patients who had cirrhosis as well as clotting diagnoses were compared with the data from patients with cirrhosis who had no clotting episodes. The data from these two patient populations were plotted and analyzed for correlation. Results: There were 5,513 lab entries extracted from 514 patients during the specified time frame, of which 1,288 entries were from 48 patients who had both cirrhosis and at least one documented clotting episode. The mean ratio of albumin to platelets for the patients with cirrhosis and who developed clots was 0.036 (±0.033) whereas the ratio of albumin to platelets for the patients with cirrhosis but no clots was 0.034 (±0.028). Meanwhile, the mean ratios of INR to platelets for patients who had clots were 0.023 (±0.025) and for patients who had no-clots were 0.023 (±0.020). When the ratios of albumin to platelets were plotted against the ratios of INR to platelets, the data follow a linear relationship. The trend line equation for the population with clots was determined to be at Y = 0.6195x + 0.0007 (R2 = 0.6737), while the patient population who had no-clots was Y= 0.5184x + 0.0056 (R2 = 0.5425). When the two graphs were superimposed, the two lines separated at the level where the ratio of INR to platelet exceeded 0.05. Conclusions: The ratio of INR to platelets may be used to determine the clotting risk in patients with cirrhosis. The study revealed that cirrhotic patients who developed clots have a unique relationship within the three commonly drawn labs: albumin, INR, and platelets. The graphs of the ratios of albumin to platelets and INR to platelets were observed to follow a linear relationship among the two populations - patients who have clots vs. ...
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