Shamseddeen Hani, Patidar Kavish R, Ghabril Marwan, Desai Archita P, Nephew Lauren, Kuehl Sandra, Chalasani Naga, Orman Eric S
Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis.
Pharmacy, Indiana University Health University Hospital, Indianapolis.
Am J Med. 2020 Dec;133(12):1479-1487.e2. doi: 10.1016/j.amjmed.2020.04.029. Epub 2020 May 29.
Thromboelastography (TEG) provides a global assessment of hemostasis and may have value for patients with cirrhosis who have multiple hemostatic defects. We sought to examine the characteristics of TEG in hospitalized patients with cirrhosis and its relationship with outcomes.
We performed a cohort study of all adults with cirrhosis hospitalized at Indiana University Hospital between November 2015 and October 2018 with a TEG. We examined the relationships among TEG, traditional measures of hemostasis, liver disease severity, and outcomes, including mortality, discharge to hospice, length of stay, and 30-day readmission.
A total of 344 patients met inclusion and exclusion criteria. R-value was elevated (≥10 min) in 4.5%, alpha angle was low (<45°) in 9.3%, and maximum amplitude (maximum amplitude) was low (<55 mm) in 72.1%. K-value, alpha angle, and maximum amplitude were all correlated with both platelet count and fibrinogen (absolute rho range 0.52-0.67); R-value and international normalized ratio (INR) were not strongly correlated with traditional measures or TEG, respectively. Patients with bleeding had hypercoagulable profiles, and patients with infection had increased R-value and decreased alpha angle. A total of 35.8% died or were discharged to hospice, and these patients had a greater R-value and smaller alpha angle. However, after adjustment for model for end-stage liver disease (MELD), neither R-value nor alpha angle were associated with discharge outcomes.
TEG provides insight into the hemostatic state of patients with cirrhosis beyond that of standard measures of hemostasis. It is associated with liver disease severity and outcomes and may play a role complementary to standard measures of hemostasis in this population.
血栓弹力图（TEG）可对止血进行全面评估，对于存在多种止血缺陷的肝硬化患者可能具有重要价值。我们旨在研究住院肝硬化患者的TEG特征及其与预后的关系。
我们对2015年11月至2018年10月期间在印第安纳大学医院住院且接受TEG检测的所有成年肝硬化患者进行了一项队列研究。我们研究了TEG、传统止血指标、肝病严重程度与预后（包括死亡率、转至临终关怀机构、住院时间和30天再入院率）之间的关系。
共有344例患者符合纳入和排除标准。4.5%的患者R值升高（≥10分钟），9.3%的患者α角降低（<45°），72.1%的患者最大振幅（MA）降低（<55毫米）。K值、α角和最大振幅均与血小板计数和纤维蛋白原相关（绝对相关系数范围为0.52 - 0.67）；R值和国际标准化比值（INR）分别与传统指标或TEG的相关性不强。出血患者的凝血状态呈高凝，感染患者的R值升高且α角降低。共有35.8%的患者死亡或转至临终关怀机构，这些患者的R值更高且α角更小。然而，在调整终末期肝病模型（MELD）后，R值和α角均与出院结局无关。
TEG能提供超出标准止血指标的肝硬化患者止血状态信息。它与肝病严重程度和预后相关，在该人群中可能发挥与标准止血指标互补的作用。
