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Assessment of validity of INR system for patients with liver disease associated with viral hepatitis

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Abstract

International Normalized Ratio (INR), which standardizes prothrombin time (PT) during oral anticoagulation, has been extended to standardize PT in liver diseases and is included in all prognostic models of survival, the classification of CHILD-Pugh or Meld. However, the mechanisms of PT prolongation in liver diseases differ from those involved in oral anticoagulation. Our aim was to assess the validity of the INR system for patients with liver disease associated with viral hepatitis. We prospectively collected blood samples from 61 patients with liver disease associated with viral hepatitis; control patients were on warfarin (n = 20). PTs were measured on a STA-R coagulometer with six thromboplastin reagents, and INRs were calculated using instrument-specific ISIs. Simultaneously, we selected 15 pairs of patients in the study population and in the control population such that INR values for each patient pair are almost equal. For these 15 pairs of patients, we performed factor assays and measured the coagulant activities of factors II, V, VI, and X and fibrinogen. Analysis of results for the control population confirms the validity of the INR system for patients on oral anticoagulants in that there was no significant difference between the reported INRs for the six different thromboplastin reagents. Conversely, for the study population, there was a significant difference between the INR results using the different reagents. Results for fibrinogen and factors V, VII, and X showed significant differences between the two groups; however, control and patient results for factor II were not statistically different. The INR system is not valid for comparison of patients with liver disease associated with viral hepatitis because different reagents do not yield the same INR for the same sample.

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Acknowledgement

We gratefully acknowledge the help by Dr. Annie Robert who provided us with the thromboplastin reagents and QI LI, Martine Migaud Fressart and Florence Ameline for technical assistance.

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Authors and Affiliations

  1. Graduate School of the Chinese P.L.A. General Hospital, Beijing, People’s Republic of China

    YuXiang Wei & BingYi Shi

  2. Organ Transplant Center, Second Affiliated Hospital of Chinese P.L.A. General Hospital, No. 17A Heishanhu Road, Beijing, 100091, People’s Republic of China

    YuXiang Wei, DeHua Zheng & BingYi Shi

  3. Department of Clinical Laboratory, Chinese P.L.A. General Hospital, No. 28 Fuxing Road, Beijing, 100853, People’s Republic of China

    Jian Li, LiWen Zhang & YuLong Cong

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  1. YuXiang Wei
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  2. Jian Li
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  3. LiWen Zhang
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  4. DeHua Zheng
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  5. BingYi Shi
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  6. YuLong Cong
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Correspondence to BingYi Shi or YuLong Cong.

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Wei, Y., Li, J., Zhang, L. et al. Assessment of validity of INR system for patients with liver disease associated with viral hepatitis. J Thromb Thrombolysis 30, 84–89 (2010). https://doi.org/10.1007/s11239-009-0423-2

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  • DOI: https://doi.org/10.1007/s11239-009-0423-2

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