Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
Department of Pediatric Hepatology and Gastroenterology, Max Hospital, New Delhi, India.
Ann Hepatol. 2018 Oct 16;17(6):1042-1051. doi: 10.5604/01.3001.0012.7205.
Patients with acute on chronic liver failure (ACLF) have abnormal conventional coagulation tests- platelet count and international normalized ratio (INR). Thromboelastography (TEG) is a rapid, point-of-care assay, more comprehensive than platelet count and INR as it assesses for platelet adequacy (number and function), coagulation factors and clot retraction. The aim of the study was to evaluate the TEG parameters in patients with ACLF, chronic liver disease having acute decompensation (AD) and healthy subjects (HC).
TEG parameters were assessed in patients with ACLF and AD within 24 h of admission. Consecutive patients were included in the study over 12 months. Healthy subjects were recruited as controls.
179 patients were included- 68 ACLF, 53 AD and 58 HC. The mean values of INR in ACLF, AD and HC groups were 2.9 ± 1.4, 1.6 ± 0.4 and 1.1 ± 0.2; P < 0.001. Among TEG parameters - maximum amplitude (MA) was low in ACLF and AD patients as compared with HC (53.8 ± 15, 58.3 ± 13.9 mm and 67.2 ± 12.1 mm, respectively; P < 0.001). Lysis at 30 min (LY30) was high in ACLF patients, as compared to AD and HC (8.6 ± 14.1%, 5.0 ± 9.5% and 4.9 ± 9.8%, respectively; P = 0.060). There were no differences in r time, k time, and alpha angle between groups; normal in >90% patients. There was no difference in TEG parameters between different ACLF grades, whereas CCTs were more deranged with increasing grades of ACLF.
Despite abnormal conventional coagulation tests, TEG parameters in ACLF patients are essentially normal, except reduced maximum amplitude. Future studies are needed to explore the utility of TEG in clinical management of ACLF patients.
患有慢加急性肝衰竭（ACLF）的患者常规凝血检测-血小板计数和国际标准化比值（INR）异常。血栓弹力图（TEG）是一种快速的即时检测方法，比血小板计数和 INR 更全面，因为它评估血小板的充足性（数量和功能）、凝血因子和血凝块回缩。本研究的目的是评估 ACLF 患者、急性肝功能失代偿（AD）的慢性肝病患者和健康受试者（HC）的 TEG 参数。
在入院后 24 小时内评估 ACLF 和 AD 患者的 TEG 参数。在 12 个月内连续纳入患者。健康受试者作为对照招募。
共纳入 179 例患者-68 例 ACLF、53 例 AD 和 58 例 HC。ACLF、AD 和 HC 组的 INR 平均值分别为 2.9 ± 1.4、1.6 ± 0.4 和 1.1 ± 0.2；P < 0.001。在 TEG 参数中-最大振幅（MA）在 ACLF 和 AD 患者中均低于 HC（分别为 53.8 ± 15、58.3 ± 13.9 和 67.2 ± 12.1 毫米；P < 0.001）。与 AD 和 HC 相比，ACLF 患者的 30 分钟溶血（LY30）较高（分别为 8.6 ± 14.1%、5.0 ± 9.5%和 4.9 ± 9.8%；P = 0.060）。r 时间、k 时间和 alpha 角在各组之间无差异；90%以上患者正常。不同 ACLF 分级之间的 TEG 参数无差异，而随着 ACLF 分级的增加，CCT 更为紊乱。
尽管常规凝血检测异常，但 ACLF 患者的 TEG 参数基本正常，除了最大振幅降低。需要进一步研究 TEG 在 ACLF 患者临床管理中的应用。
