Plasma granulocyte elastase levels and its relation to D-dimer in liver cirrhosis

Objective: Do plasma granulocyte elastase levels in liver cirrhosis influence D-dimer levels?

Setting: University Hospital.

Materials: We investigated plasma granulocyte elastase levels in 65 patients with liver cirrhosis and related it to D-dimer levels determined by enzyme linked immunoassay. Granulocyte elastase was carried out by heterogenous enzyme immunoassay using polymorphonuclear Elastase kit (Diagnostica Merck, Darmstadt, Germany).

Results: The mean plasma levels of elastase (175.4 μg/l) and D-dimer (2732.7 μg/l) were significantly increased in patients with cirrhosis as compared to levels of normal subjects (elastase: 22 μg/l; D-dimer: 276 μg/l). There was no significant difference of elastase levels among Child classes (P =0.010) and etiology of cirrhosis (P =0.007). D-dimer levels were significantly different among different Child groups (P =0.020). Plasma elastase levels were positively correlated with D-dimer levels (r=0.437, P< 0.001).

Conclusions: We have demonstrated a marked increase of granulocyte elastase and its relation to plasma D-dimer levels in patients with cirrhosis. This findings suggest that accelerated fibrinolysis in cirrhosis may be associated with cellular neutrophil activation and elevated granulocyte elastase level may be partially responsible for elevated D-dimer in cirrhosis.