Child single worst criterion as a predictor of hemostatic state in patients with liver cirrhosis

In liver cirrhosis, the severity of the coagulation disorder is closely related to the severity of the liver dysfunction. A complete hemostatic evaluation involves a multitude of complex measurements which is time consuming and requires a much longer time than the liver function assessment itself. The author has selected the Child criteria for the “worst criteria study” as it way the simplest to use. Hemostatic assessment was performed on 121 cases of liver cirrhosis, i.e., fibrinogen, factors II, VII, IX, X, AT III levels, prothrombin time and partial thromboplastin time. The patients were divided into 3 gorups, i.e., Child A 18 cases, Child B 48 cases, and Child C 53 cases. Sixty five normal volunteers were used as controls. The levels offibrinogen, factors II, IX, X, as well as AT III and the prothrombin times among normal persons were significantly different (p <0.05) from Child A, except for factor VII (p = 0.3085) and PTT (p = 0.3009). There was a significant difference between Child A and Child B liver cirrhosis patients in their hemostasis results (p < 0.05), except for fibrinogen (p = 0.1578) and factor IX (p = 0.0673), whereas all hemostatic parameters were significantly different between Child B and Child C patients. The above data shows that the Child single worst criterion as related to the severity of liver cirrhosis can be utilized to determine the severity of the hemostatic abnormality. The hemostatic screening tests performed on normal persons and Child A liver cirrhosis patients revealed significant difference in the prothrombin time (p < 0.0012) whereas the PTT was not significantly different (p = 0.3009). This data reminds us of the importance of the prothrombin tests in cirrhosis patients.