Thromboelastography maximum amplitude predicts short‑term mortality in patients with hepatitis B virus‑related acute‑on‑chronic liver failure

Zhu, Zhe; Yu, Yanyan; Ke, Yefang; Deng, Danfei; Zheng, Guodong; Hua, Xin; Gao, Guosheng

doi:10.3892/etm.2020.8990

Cited by 3 publications

(7 citation statements)

References 31 publications

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“…However, protein C activity (<30%), but not clot lysis, is an independent predictor of mortality in patients with ACLF after adjusting for age, gender and baseline MELD. 55 INR (AUROC = 0.865, p = 0.001) seems to have a higher predictive value of mortality than MA (AUROC = 0.771, p = 0.001) in ACLF 61 . Additionally, R and α are not associated with the mortality or hospice in patients with cirrhosis after adjusting for MELD score or presence of ACLF 13 .…”

Section: Teg Profile and In Liver Dise A Se Smentioning

confidence: 90%

“…59 There is a significant difference in haemostatic status indicated by TEG profile and CCTs between ACLF patients who survived and died. 18,60,61 TEG parameters, mainly including K, α, MA, clot lysis and coagulation index, 55,61 can predict the short-term outcome of patients with ACLF. However, protein C activity (<30%), but not clot lysis, is an independent predictor of mortality in patients with ACLF after adjusting for age, gender and baseline MELD.…”

Section: Teg Profile and In Liver Dise A Se Smentioning

confidence: 99%

“…Short‐term mortality of ACLF is high, 16 and can be evaluated by the severity of coagulopathy 59 . There is a significant difference in haemostatic status indicated by TEG profile and CCTs between ACLF patients who survived and died 18,60,61 . TEG parameters, mainly including K, α, MA, clot lysis and coagulation index, 55,61 can predict the short‐term outcome of patients with ACLF.…”

Section: Teg Profile and Survival In Liver Diseasesmentioning

confidence: 99%

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Review article: thromboelastography in liver diseases

Yao

Ageno

et al. 2022

Aliment Pharmacol Ther

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Summary Background Patients with liver diseases have complicated haemostatic alternations, resulting in both bleeding and thromboembolic complications, which cannot be sufficiently evaluated by conventional coagulation tests (CCTs), such as platelet count or prothrombin time. Thromboelastography (TEG) is a whole blood viscoelastic test which globally reflects changes in the haemostatic system, and its utility in evaluating patients with liver disease is increasingly recognised. Aims To review the current evidence and clinical significance of TEG in liver diseases. Methods Literature regarding TEG and liver diseases was comprehensively searched. Results TEG is associated closely with the severity and aetiology of liver disease, the course of infection and the risk of bleeding and death, but not the risk of portal venous system thrombosis. Additionally, TEG‐guided transfusion protocols can significantly decrease the requirement for blood products compared to those guided by CCTs. Conclusion TEG can reflect the haemostatic status of liver diseases more comprehensively than CCTs. It has the potential to assess the severity of liver diseases, predict the risk of bleeding and death in patients with liver disease and guide blood product transfusion. Future studies should standardise the use of TEG for assessing disease severity and development of clinical events and guiding blood product transfusion in patients with liver diseases.

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Section: Teg Profile and In Liver Dise A Se Smentioning

confidence: 90%

Section: Teg Profile and In Liver Dise A Se Smentioning

confidence: 99%

Section: Teg Profile and Survival In Liver Diseasesmentioning

confidence: 99%

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Review article: thromboelastography in liver diseases

Yao

Ageno

et al. 2022

Aliment Pharmacol Ther

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“…At baseline, the PELD (28 [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] versus 31 [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38]; P = 0.28), MELD (25 [24][25][26][27][28][29][30] versus 32 [27][28][29][30][31][32]; P = 0.93), CTP (12 Vinayagamoorthy et al [11][12] versus 12 [12][13]; P = 0.6), and pCLIF-SOFA score (7 [6-8] versus 7 [6][7]…”

Section: Severity Of Liver Dysfunction and Tegmentioning

confidence: 99%

Hypocoagulability in Children With Decompensated Chronic Liver Disease and Sepsis: Assessment by Thromboelastography

Vinayagamoorthy¹,

Srivastava²,

Das³

et al. 2023

JPGN Reports

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Objective: To evaluate the coagulation status of children with decompensated chronic liver disease (DCLD) and infection and factors affecting it using thromboelastography (TEG). Methods: Coagulation status of children admitted with DCLD and infection was assessed by international normalized ratio (INR), platelet count, and TEG [reaction time (R), kinetic time (K), α-angle (AA), maximum amplitude (MA), coagulation index (CI), and lysis index (LY30)] at admission and at 7–14 days after treatment. CI < −3 represents hypocoagulable state. Clinical profile including systemic inflammatory response syndrome (SIRS), infection severity, bleeding, treatment response, and outcome were noted. Results: Thirty children (21 boys, median (IQR) age 78 [15.7–180] months) were studied prospectively. At admission, 29 (96.7%) had prolonged INR, 24 (80%) had thrombocytopenia, and 17 (56.6%) were hypocoagulable by TEG. Nine of 30 (30%) had normal TEG but deranged INR and platelets. Nineteen (63.3%) cases had SIRS, 11 (36.6%) had severe sepsis, and 8 (26.6%) had bleeding. Hypocoagulable state was common in severe sepsis than sepsis/infection (81.1% versus 42.1%; P = 0.05) and persistent (n = 4) versus recovered SIRS (n = 15, 100% versus 33%; P = 0.03). Bleeders had prolonged R-time (7.8 versus 5.4 min; P = 0.03), smaller MA (30.2 versus 47 mm; P = 0.05), and α-angle (40.4 versus 62.9; P = 0.03) but similar INR and platelets than nonbleeders. Six patients (20%) had poor in-hospital outcomes; R-time ≥8.5 min predicted mortality with high sensitivity (83%) and specificity (100%). Conclusions: Fifth-seven percent of children with DCLD and infection were hypocoagulable by TEG. Severe sepsis and persistent SIRS worsened the coagulation status. TEG identifies bleeders better than INR and platelet count. R-time ≥8.5 min predicts a poor hospital outcome.

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“…In addition, among the enrolled ACLF patients, those with a hypocoagulation TEG profile had a significantly higher risk of bleeding [hazard ratio (HR) 2.1; CI: 1.6-4.9; P = 0.050] and short-term mortality (HR 1.9; CI: 1.3-7.9; P = 0.043). A more recent Chinese report[ 45 ] compared 51 hepatitis B virus-related cases of ACLF with healthy controls and patients with fully compensated chronic hepatitis B. They found that the coagulation dynamics were significantly altered in ACLF, with higher R and K times and lower α angles and MAs, corresponding to a marked hypocoagulable state.…”

Section: Hypercoagulability Thrombosis and Vet In Liver Cirrhosismentioning

confidence: 99%

Viscoelastic tests in liver disease: where do we stand now?

Buliarca

Horhat

Mocan

et al. 2021

WJG

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Hemostasis is a complex physiological process based on the balance between pro-coagulant and anticoagulant systems to avoid pathological bleeding or thrombosis. The changes in standard coagulation tests in liver disease were assumed to reflect an acquired bleeding disorder, and cirrhotic patients were considered naturally anticoagulated. In the light of the new evidence, the theory of rebalanced hemostasis replaced the old concept. According to this model, the hemostatic alteration leads to a unique balance between pro-coagulant, anticoagulant, and fibrinolytic systems. But the balance is fragile and may prone to bleeding or thrombosis depending on various risk factors. The standard coagulation tests [INR (international normalized ratio), platelet count and fibrinogen] only explore parts of the hemostasis, not offering an entire image of the process. Rotational thromboelastometry (ROTEM) and thromboelastography (TEG) are both point of care viscoelastic tests (VET) that provide real-time and dynamic information about the entire hemostasis process, including clot initiation (thrombin generation), clot kinetics, clot strength, and clot stability (lysis). Despite prolonged PT/INR (international normalized ratio of prothrombin time) and low platelet counts, VET is within the normal range in many patients with both acute and chronic liver disease. However, bleeding remains the dominant clinical issue in patients with liver diseases, especially when invasive interventions are required. VET has been shown to asses more appropriately the risk of bleeding than conventional laboratory tests, leading to decrial use of blood products transfusion. Inappropriate clotting is common but often subtle and may be challenging to predict even with the help of VET. Although VET has shown its benefit, more studies are needed to establish cut-off values for TEG and ROTEM in these populations and standardization of transfusion guidelines before invasive interventions in cirrhotic patients/orthotopic liver transplantation.

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Thromboelastography maximum amplitude predicts short‑term mortality in patients with hepatitis B virus‑related acute‑on‑chronic liver failure

Cited by 3 publications

References 31 publications

Review article: thromboelastography in liver diseases

Review article: thromboelastography in liver diseases

Hypocoagulability in Children With Decompensated Chronic Liver Disease and Sepsis: Assessment by Thromboelastography

Viscoelastic tests in liver disease: where do we stand now?

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