Plasminogen as a Marker for Assessing Thrombotic Risk During Hepatitis in Cameroon: Case–Control Study

Background and Aims

The liver synthesizes coagulation factors, anticoagulants, proteins involved in fibrinolysis, and the platelet production regulator, thrombopoietin, from megakaryocytes. Importantly, hepatic dysfunction that arises from hepatitis may perturb the clotting process. This study aims to determine these patients' plasminogen levels and hemostasis disorders to assess the thrombotic risk.

Methods

An analytical case-control study was carried out over 6 months. The study included hepatitis B, C, and D patients from Bafoussam Regional Hospital and Laquinitie Hospital in Douala-Cameroon, compared to healthy controls, to evaluate differences in hemostasis and thrombotic risk. Control tests were performed using the immunochromatographic and ELISA methods. Blood Count was performed by flow cytometry method. And determination of d-dimer and plasminogen by nephelometry and ELISA respectively; finally the evaluation of the enzymatic activity of alanine aminotransferase and aspartate aminotransferase (ALT and AST) by the spectrophotometric kinetic method. The results were recorded in an Excel spreadsheet and analyzed using the statistical software R version 4.1.1.

Results

The population size was 340 participants including 162 controls (47.7%) and 178 (52.3%) cases of which 136 cases of hepatitis B (76.4%), 26 cases of hepatitis C (14.6%), and 16 cases of hepatitis D (9%). The sex ratio was 3.15 in favor of men; including 1.7 in cases and 9.1 in controls. All patients had a thrombotic risk characterized by a decrease in plasminogen levels compared to controls (p < 0.001). 13.5% of the population had thrombocytopenia compared to none among controls (p < 0.001). The following parameters are associated with risk of developing thrombosis in this study in particular Hepatitis (aOR = 3; 95% CI [1.01–5.2]; p < 0.03), plasminogen decrease (aOR = 3; 95% CI [1.01–5.2]; p < 0.03), shortening cephalin time activator (CTA) (aOR = 1.5; 95% CI [1.1–5.2]; p < 0.04), and decreased hemoglobin (aOR = 2.1; 95% CI [1.1–5.1;]; p < 0.03).

Conclusion

This study shows a decrease in plasminogen in patients during hepatitis. It suggests it is an important element to evaluate the thrombotic risk although the exploration of other coagulation tests should be associated with it for a complete and exhaustive evaluation and a better final diagnosis.