Thrombin generation is increased in patients with Clostridium difficile colitis - a pilot study.

Background: There are only limited data in the literature on the thrombotic risk of patients with Clostridium difficile (CD) colitis, although this disease is widespread throughout the world. Objective: The aim of this study was to explore thrombin generation in these patients - the best way to evaluate their coagulation. Methods: A prospective observational study was conducted during 15 months on hospitalized patients with CD colitis. Thrombin generation was performed in platelet-poor plasma using a Ceveron® alpha analyzer and was compared with a group of volunteer control subjects. Results: Thirty-three patients and 51 control subjects were enrolled in the study. Two biomarkers - mean velocity index and peak thrombin - were significantly higher in patient group, compared to the control subjects (p = 0.010, respectively, p = 0.0395). This pattern of thrombin generation suggests that patients with CD colitis without septic shock have a potential thrombotic risk. The mean velocity index significantly correlated with the estimated related risk of death according to the Charlson age-comorbidity index. Conclusions: The higher values of thrombin generation suggest that CD colitis increases the thromboembolic risk. The pattern of thrombin generation could identify patients with particularly higher thromboembolic risk. They are potential candidates for thromboprophylaxis strategies and monitorization.

Thrombin Generation in Chronic Liver Diseases-A Pilot Study.

The knowledge about coagulation disorders in patients with chronic liver disease changed in the last decade. The aim of this study was to analyze the parameters of thrombin generation in patients with chronic liver disease, as they are the most appropriate biomarkers to explore coagulation. (1) Background: The knowledge about coagulation disorders in patients with chronic liver disease changed in the last decade. The study of thrombin generation in patients with chronic liver disease provides a much more accurate assessment of the coagulation cascade; (2) Methods: This study is a prospective observational pilot study on hospitalized patients with chronic liver diseases that analyzed thrombin generation performed from their platelet-poor plasma versus that of control subjects. We analyzed a group of 59 patients with chronic liver disease and 62 control subjects; (3) Results: Thrombin generation was lower in hepatitis and cirrhosis patients compared to controls and decreases as the disease progressed. Lag time was higher in ethanolic etiology compared to the control group. Peak thrombin and endogenous thrombin potential were shorter in all etiologies when compared to the control group. The velocity index was significantly lower in HCV hepatopathies, ethanolic, and mixed etiology when compared with normal individuals; (4) Conclusions: Given the variability of thrombin generation in patients with chronic liver disease, its assay could serve to identify patients with high thrombotic and hemorrhagic risk and establish personalized conduct toward them.

Erythropoietin and the pro-inflammatory cytokines in chronic C hepatitis.

BACKGROUND/AIMS: Erythropoietin has an antiinflammatory action. We proposed to study its effects on patients with chronic hepatitis C. METHODOLOGY: We studied a group of 96 hospitalized patients. Those with viral chronic hepatitis C were divided into 2 groups: group A--41 patients with chronic renal failure, and group B--23 patients without renal failure. 32 patients without any hepatitis viruses formed the control group--C. We analyzed: the biochemical tests, the serum IL-6, IL-8, TNF-alpha, C reactive protein, and erythropoietin. RESULTS: The levels of pro-inflammatory cytokines and of erythropoietin were higher in the patients from groups A and B, except the value of TNF-alpha from group B. The dialyzed patients had higherpro-inflammatory cytokines and lower erythropoietiin comparing with the non-dialyzed patients. CONCLUSIONS: Erythropoietin levels and some proinflammatory cytokines increasein patients with chronic hepatitis C. Erythropoietin could have an anti-inflammatory effect on thepatients without renal failure.

Lovastatin and fluvastatin reduce viremia and the pro-inflammatory cytokines in the patients with chronic hepatitis C.

BACKGROUNDS/AIMS: Certain statins interfere with the mechanism of the hepatitis C virus replication. We aimed at studying the effect of statins on the level of viremia and of the pro-and anti-inflammatory cytokines in the patients with chronic hepatitis C. METHODOLOGY: We took in our study all the patients with chronic hepatitis C placed in the evidence of the clinics of internal medicine of the Emergency County Clinical Hospitals of Brasov, Oradea and Sibiu, who had been identified with viremias. The patients were treated with fluvastatin 40 mg/day or lovastatin 20 mg/day for 28 days. The level of viremia, hemoleukogram, hepatic biochemical tests and the pro and anti-inflammatory hepatic cytokines were analysed before and after the treatment. The final results were compared with the initial ones, as well as between the 2 groups. RESULTS: Regarding those 99 analysed patients, the initial average viremia was of 2376074 +/- 3427596 UI/ml, while the final one was of 1321136 +/- 1343570 UI/ml (p = 0.000987). Both, in the group treated with lovastatin, as well as in that treated with fluvastatin, the decrease of viremia was significant from the statistics point of view (p = 0.032, respectively p = 0.00092). Lovastatin administration resulted in the significant decrease of the pro-inflammatory cytokines IL-6 and TNF-alfa, while that of fluvastatin brought about the significant decrease of the serum levels of IL-6, IL-8 and TNF-alfa. There were no significant differences, statistically speaking, between the 2 determinations, regarding the levels of IL-10 (anti-inflammatory cytokine) and those of erythropoietin. Transaminases average level did not vary significantly after those 4 weeks of statins treatment. CONCLUSIONS: Lovastatin and fluvastatin, significantly decrease the level of viremia, of IL-6 and TNF-alpha in the patients with chronic hepatitis C.