PLASMA PROTHROMBIN IN LIVER DISEASE: ITS CLINICAL AND PROGNOSTIC SIGNIFICANCE

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Abstract
A chemical method for measuring plasma prothrombin has been utilized to study the prothrombin complex in liver disease. The method for measuring prothrombin as distinct from other clotting factors is based on the hydrolysis of a synthetic substrate, p-toluene sulfonyl-l-arginine methyl ester (TAMe) by thrombin, which is evolved from prothrombin. Case material included cirrhosis, necrosis of the liver, post-necrotic cirrhosis, hepatitis and obstructive jaundice. Extremely low TAMe prothrombin levels were found in fatal cirrhosis or necrosis. Patients with severe cirrhosis had persistently low values for months or years. Viral hepatitis was characterized by higher levels and rapidly fluctuating values. When vitamin K1 emulsion was given to patients with severe liver disease, there was little or no increase in "true" prothrombin. Accessory clotting factors rose more rapidly following recovery than prothrombin itself. Serial study of prothrombin furnishes excellent prognostic information in liver disease.