Stegewerth Klaus, Weber Christian F, Moehlmann Madara, Adam Elisabeth H, Zacharowski Kai, Zeuzem Stefan, Weiler Nina
Clin Lab. 2019 Aug 1;65(8). doi: 10.7754/Clin.Lab.2019.190505.
Collective specific variegated alterations in the hemostatic system cast doubt on the uncritical usage of standard hemotherapy algorithms in patients with chronic liver disease. The aims of the present study were to examine the applicability of commonly used early viscoelastic parameters in this particular collective and to develop first-time thresholds for the early detection of clinically relevant platelet dysfunction.
Patients suffering from advanced chronic liver disease were enrolled in this prospective single-centre study and consecutively allocated to Group 1 (MELD (Model for End-Stage Liver Disease) score 6 - 11) or Group 2 (MELD score > 16). We performed conventional laboratory coagulation analyses, as well as viscoelastometry (ROTEM®, EXTEM test, and FIBTEM test) and aggregometry (Multiplate®, ASPItest, and ADPtest), in each patient to analyze their hemostatic capacity. We analyzed the association between the A10 values (clot firmness 10 minutes after the initiation of clot building) in the EXTEM and FIBTEM tests and the corresponding Maximum Clot Firmness (MCF) values and performed receiver operating characteristic (ROC) curve analyses to investigate the ability of early parameters from the ASPItest and ADPtest (Aggregation Units (AU) 1 minute (T1), 2 minutes (T2) and 3 minutes (T3) after induction of platelet aggregation) of the Multiplate® system to predict clinically relevant platelet dysfunction.
In the complete study collective (n = 50) and in Group 1 and Group 2 (each n = 25), A10 values correlated highly significantly with corresponding MCF values. The bias between the A10 and the MCF values was 5.1 ± 2.4 mm and 1.2 ± 1.1 mm for the EXTEM test and FIBTEM test, respectively. The highest sensitivity and specificity values for the prediction of clinically relevant platelet dysfunction at measuring point T3 were analyzed to be the values 54.9 AU/min in the ASPItest and 50.1 AU/min in the ADPtest.
The results of the study indicate that the basic principle of using the A10 values as so-called early vis-coelastic parameters for the estimation of MCF values is legitimate. The presumably divergent bias between the A10 and MCF values necessitates the development of collective specific thresholds in hemotherapy algorithms for coagulopathic patients suffering from advanced chronic liver disease.
止血系统中集体性的特定多样化改变使人对慢性肝病患者不加批判地使用标准血液治疗算法产生怀疑。本研究的目的是检验常用的早期粘弹性参数在这一特定群体中的适用性，并首次制定用于早期检测临床相关血小板功能障碍的阈值。
患有晚期慢性肝病的患者被纳入这项前瞻性单中心研究，并连续分配至第1组（终末期肝病模型（MELD）评分6 - 11）或第2组（MELD评分> 16）。我们对每位患者进行了常规实验室凝血分析、粘弹性测定（ROTEM®、EXTEM试验和FIBTEM试验）以及凝集测定（Multiplate®、ASPItest和ADPtest），以分析其止血能力。我们分析了EXTEM和FIBTEM试验中A10值（凝血形成开始10分钟后的血凝块硬度）与相应的最大血凝块硬度（MCF）值之间的关联，并进行了受试者操作特征（ROC）曲线分析，以研究Multiplate®系统中ASPItest和ADPtest（血小板聚集诱导后1分钟（T1）、2分钟（T2）和3分钟（T3）的聚集单位（AU））的早期参数预测临床相关血小板功能障碍的能力。
在整个研究群体（n = 50）以及第1组和第2组（每组n = 25）中，A10值与相应MCF值高度显著相关。EXTEM试验和FIBTEM试验中，A10值与MCF值之间的偏差分别为5.1±2.4毫米和1.2±1.1毫米。在测量点T3预测临床相关血小板功能障碍的最高敏感性和特异性值经分析分别为ASPItest中的54.9 AU/分钟和ADPtest中的50.1 AU/分钟。
研究结果表明，将A10值用作估计MCF值的所谓早期粘弹性参数的基本原理是合理的。A10值与MCF值之间可能存在的不同偏差使得有必要为患有晚期慢性肝病的凝血病患者制定血液治疗算法中的群体特异性阈值。
