Thakrar Sonali V, Mallett Susan V
Sonali V Thakrar, Susan V Mallett, Royal Free Perioperative Research Group, Department of Anaesthesia, Royal Free London, London NW3 2QG, United Kingdom.
World J Hepatol. 2017 Feb 28;9(6):318-325. doi: 10.4254/wjh.v9.i6.318.
To investigate the relationship between baseline platelet count, clauss fibrinogen, maximum amplitude (MA) on thromboelastography, and blood loss in orthotopic liver transplantation (OLT).
A retrospective analysis of our OLT Database (2006-2015) was performed. Baseline haematological indices and intraoperative blood transfusion requirements, as a combination of cell salvage return and estimation of 300 mls/unit of allogenic blood, was noted as a surrogate for intraoperative bleeding. Two groups: Excessive transfusion (> 1200 mL returned) and No excessive transfusion (< 1200 mL returned) were analysed. All data analyses were conducted using IBM SPSS Statistics version 23.
Of 322 OLT patients, 77 were excluded due to fulminant disease; redo transplant or baseline haemoglobin (Hb) of < 80 g/L. One hundred and fourteen (46.3%) were classified into the excessive transfusion group, 132 (53.7%) in the no excessive transfusion group. Mean age and gender distribution were similar in both groups. Baseline Hb ( ≤ 0.001), platelet count ( = 0.005), clauss fibrinogen ( = 0.004) and heparinase MA ( = 0.001) were all statistically significantly different. Univariate logistic regression with a cut-off of platelets < 50 × 10/L as the predictor and Haemorrhage as the outcome showed an odds ratio of 1.393 (95%CI: 0.758-2.563; = 0.286). Review of receiver operating characteristic curves showed an area under the curve (AUC) for platelet count of 0.604 (95%CI: 0.534-0.675; = 0.005) as compared with AUC for fibrinogen level, 0.678 (95%CI: 0.612-0.744; ≤ 0.001). A multivariate logistic regression shows United Kingdom model for End Stage Liver Disease ( = 0.006), Hb ( = 0.022) and Fibrinogen ( = 0.026) to be statistically significant, whereas Platelet count was not statistically significant.
Platelet count alone does not predict excessive transfusion. Additional investigations, ., clauss fibrinogen and viscoelastic tests, provide more robust assessment of bleeding-risk in thrombocytopenia and cirrhosis.
探讨原位肝移植（OLT）中基线血小板计数、克劳斯纤维蛋白原、血栓弹力图最大振幅（MA）与失血之间的关系。
对我们的OLT数据库（2006 - 2015年）进行回顾性分析。记录基线血液学指标和术中输血需求，将细胞回收量与每单位300毫升异体血估计量相结合，作为术中出血的替代指标。分析两组：过量输血组（回输量>1200毫升）和非过量输血组（回输量<1200毫升）。所有数据分析均使用IBM SPSS Statistics 23版进行。
在322例OLT患者中，77例因暴发性疾病、再次移植或基线血红蛋白（Hb）<80克/升被排除。114例（46.3%）被分类为过量输血组，132例（53.7%）为非过量输血组。两组的平均年龄和性别分布相似。基线Hb（≤0.001）、血小板计数（=0.005）、克劳斯纤维蛋白原（=0.004）和肝素酶MA（=0.001）均有统计学显著差异。以血小板<50×10⁹/L为预测指标、出血为结果的单因素逻辑回归显示比值比为1.393（95%置信区间：0.758 - 2.563；=0.286）。对受试者工作特征曲线的回顾显示，血小板计数的曲线下面积（AUC）为0.604（95%置信区间：0.534 - 0.675；=0.005），而纤维蛋白原水平的AUC为0.678（95%置信区间：0.612 - 0.744；≤0.001）。多因素逻辑回归显示，英国终末期肝病模型（=0.006）、Hb（=0.022）和纤维蛋白原（=0.026）具有统计学显著性，而血小板计数无统计学显著性。
仅血小板计数不能预测过量输血。其他检查，如克劳斯纤维蛋白原和粘弹性试验，能更可靠地评估血小板减少和肝硬化患者的出血风险。
