Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy.
Teaching Hospital "Duilio Casula", Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy.
Int J Lab Hematol. 2019 Feb;41(1):118-123. doi: 10.1111/ijlh.12934. Epub 2018 Oct 9.
Prothrombin time is thought to be unreliable in cirrhotic patients to predict the risk of bleeding. We investigated whether prothrombin time ratio was an independent risk factor for bleeding alongside its clot waveform analysis.
We studied 307 consecutive cirrhotic patients and 115 healthy subjects. A coagulometer was used for detecting both prothrombin time and clot waveform analysis which included velocity (1st derivative) and acceleration (2nd derivative) of clot formation, and area of parabolic segment of the 1st and 2nd derivatives of prothrombin time (entire cycle of the clot formation).
Logistic regression shows that prothrombin time ratio was the only variable significantly associated with the history of bleeding. Using a hemorrhagic score, the stepwise model included prothrombin time ratio and the area of parabolic segment of the 1st derivative of Prothrombin Time. Odds ratio was used to create a new score to be challenged against the hemorrhagic score in a ROC analysis. The AUC was 0.72, 95% CI: 0.67-0.77.
Prothrombin time ratio is associated to an increased bleeding risk. Its role may be further emphasized considering clot waveform analysis. The new score, if aggregated to prothrombin time ratio, could be useful to provide a single parameter immediately ready to assess the bleeding risk in the individual cirrhotic patient.
凝血酶原时间被认为在预测肝硬化患者出血风险方面不可靠。我们研究了凝血酶原时间比值是否是出血的独立危险因素，同时还进行了其血栓波形分析。
我们研究了 307 例连续肝硬化患者和 115 例健康对照者。使用凝血仪检测凝血酶原时间和血栓波形分析，包括血栓形成的速度（一阶导数）和加速度（二阶导数），以及凝血酶原时间的一阶和二阶导数的抛物线段面积（血栓形成的整个周期）。
逻辑回归显示，凝血酶原时间比值是唯一与出血史显著相关的变量。使用出血评分，逐步模型包括凝血酶原时间比值和凝血酶原时间一阶导数的抛物线段面积。比值比用于创建一个新的评分，以在 ROC 分析中与出血评分进行比较。AUC 为 0.72，95%CI：0.67-0.77。
凝血酶原时间比值与出血风险增加相关。考虑到血栓波形分析，其作用可能更为重要。如果将新评分与凝血酶原时间比值结合起来，可以提供一个单一的参数，用于立即评估个体肝硬化患者的出血风险。
