CHU Bordeaux, Service d'Anesthésie-Réanimation Pellegrin, Bordeaux, France
Université de Bordeaux, INSERM U 12-11, Maladies rares: Génétique et Métabolisme, Bordeaux, France.
J Clin Pathol. 2019 Jan;72(1):58-65. doi: 10.1136/jclinpath-2018-205280. Epub 2018 Oct 3.
Diagnosis of hyperfibrinolysis in orthotopic liver transplantation (OLT) remains challenging. Euglobulin clot lysis time (ECLT) is not adapted to clinical situations. ROTEM is specific but seldom sensitive to hyperfibrinolysis. The Lysis Timer assesses 'Global Fibrinolytic Capacity' in citrated plasma (GFC/LT). GFC/LT associates reagents for in vitro triggering of the clot (thrombin and calcium) and its lysis (tissue-plasminogenactivator (t-PA)), turbidity signal acquisition by the Lysis Timer, and dedicated software converting the digital signal into an optical curve. A visual check of the curves was systematic to ascertain the lysis time values calculated by the software. The primary aim of this prospective observational study was to evaluate the ability of GFC/LT to recognise hyperfibrinolysis during OLT. The secondary aim was to compare its results with ROTEM maximum lysis (EXTEM ML) and with standard laboratory tests.
Thirty consecutive adult patients undergoing OLT were included (NCT03012633). Standard laboratory tests, ROTEM, GFC/LT, ECLT and fibrinolysis parameters were assayed at five sample times.
GFC/LT was correlated with ECLT, plasmin activator inhibitor 1 antigen and activity and t-PA activity (r=0.490, 0.681, 0.643 and -0.359, respectively). Hyperfibrinolysis was defined as ECLT ≤60 min. Receiver operating characteristic curve analysis showed that GFC/LT with a threshold of 31 min detected hyperfibrinolysis with a sensitivity of 0.88 (95% CI 0.73 to 0.96), a specificity of 0.68 (95% CI 0.56 to 0.78) and an area under the curve (AUC) of 0.85 (95% CI 0.74 to 0.94). EXTEM ML >12% did not detect hyperfibrinolysis (sensitivity 0.38 (95% CI 0.24 to 0.55), specificity 0.95 (95% CI 0.86 to 0.99) and AUC 0.60 (95% CI 0.46 to 0.75)).
GFC/LT recognised hyperfibrinolysis during OLT with a significant agreement with the other tests of fibrinolysis.
NCT03012633.
原位肝移植（OLT）中纤维蛋白溶解亢进的诊断仍然具有挑战性。优球蛋白溶解时间（ECLT）不适应临床情况。ROTEM 对纤维蛋白溶解亢进具有特异性但敏感性较低。Lysis Timer 可评估枸橼酸盐血浆中的“整体纤维蛋白溶解能力”（GFC/LT）。GFC/LT 为体外触发血栓（凝血酶和钙）及其溶解（组织纤溶酶原激活物（t-PA））提供试剂，通过 Lysis Timer 获得浊度信号，并使用专用软件将数字信号转换为光学曲线。系统地对曲线进行视觉检查以确定软件计算的溶解时间值。这项前瞻性观察研究的主要目的是评估 GFC/LT 在 OLT 期间识别纤维蛋白溶解亢进的能力。次要目的是将其结果与 ROTEM 最大溶解（EXTEM ML）和标准实验室测试进行比较。
纳入 30 例连续接受 OLT 的成年患者（NCT03012633）。在五个样本时间点测定标准实验室检查、ROTEM、GFC/LT、ECLT 和纤溶参数。
GFC/LT 与 ECLT、纤溶酶原激活物抑制剂 1 抗原和活性以及 t-PA 活性相关（r=0.490、0.681、0.643 和-0.359）。纤维蛋白溶解亢进定义为 ECLT≤60 分钟。受试者工作特征曲线分析显示，GFC/LT 阈值为 31 分钟时，检测纤维蛋白溶解亢进的灵敏度为 0.88（95%CI 0.73 至 0.96），特异性为 0.68（95%CI 0.56 至 0.78），曲线下面积（AUC）为 0.85（95%CI 0.74 至 0.94）。EXTEM ML＞12%未检测到纤维蛋白溶解亢进（灵敏度 0.38（95%CI 0.24 至 0.55），特异性 0.95（95%CI 0.86 至 0.99），AUC 0.60（95%CI 0.46 至 0.75））。
GFC/LT 在 OLT 期间识别纤维蛋白溶解亢进，与其他纤溶试验具有显著一致性。
NCT03012633。
