Faculty of Medicine, Pontifical Catholic University of Campinas, Campinas, Brazil.
School of Medical Sciences, University of Campinas, Campinas, Brazil.
J Thromb Thrombolysis. 2022 May;53(4):887-897. doi: 10.1007/s11239-021-02609-x. Epub 2021 Nov 20.
The relationship between acidosis and coagulopathy has long been described in vitro and in trauma patients, but not yet in orthotopic liver transplantation (OLT). The association of metabolic acidosis with coagulopathy and with transfusion requirements was evaluated in patients submitted to OLT. Changes in acid-base and coagulation parameters were analyzed by repeated measures. Regression analyses [adjusted for sex, age, model for end stage liver disease (MELD) score, and baseline values of hemoglobin, fibrinogen, international normalized ratio, platelets] determined the association of acid-base parameters with coagulation markers and transfusion requirement. We included 95 patients, 66% were male, 49.5% of the patients had hepatocellular carcinoma and the mean MELD score was 20.4 (SD 8.9). The values of all the coagulation and acid-base parameters significantly changed during OLT, particularly in the reperfusion phase. After adjustments for baseline parameters, the decrease in pH and base excess (BE) values were associated with a decrease in fibrinogen levels (mean decrease of fibrinogen level = 14.88 mg/dL per 0.1 unit reduction of pH values and 3.6 mg/dL per 1 mmol/L reduction of BE levels) and an increase in red blood cells transfusion (2.16 units of RBC per 0.1 unit reduction of pH and 0.38 units of RBC per 1 mmol/L reduction of BE levels). Among multiple factors potentially associated with adverse outcomes, decreasing pH levels were independently associated with the length of hospitalization but not with in-hospital mortality. Metabolic acidosis is independently associated with decreased fibrinogen levels and increased intraoperative transfusion requirement during OLT. Awareness of that association may improve treatment strategies to reduce intraoperative bleeding risk in OLT.
酸中毒与凝血障碍之间的关系早已在体外和创伤患者中得到描述，但尚未在原位肝移植（OLT）中得到描述。本研究评估了代谢性酸中毒与凝血障碍和输血需求的关系，并在接受 OLT 的患者中进行了评估。通过重复测量分析了酸碱和凝血参数的变化。回归分析[调整性别、年龄、终末期肝病模型（MELD）评分以及血红蛋白、纤维蛋白原、国际标准化比值、血小板的基线值]确定了酸碱参数与凝血标志物和输血需求的关系。我们纳入了 95 例患者，其中 66%为男性，49.5%的患者患有肝细胞癌，平均 MELD 评分为 20.4（8.9）。OLT 过程中所有凝血和酸碱参数的值均发生显著变化，特别是在再灌注阶段。在调整基线参数后，pH 值和碱剩余（BE）值的降低与纤维蛋白原水平的降低相关（pH 值每降低 0.1 单位，纤维蛋白原水平降低 14.88mg/dL；BE 值每降低 1mmol/L，纤维蛋白原水平降低 3.6mg/dL），红细胞输注增加（pH 值每降低 0.1 单位，输注红细胞 2.16 单位；BE 值每降低 1mmol/L，输注红细胞 0.38 单位）。在与不良结局相关的多种因素中，pH 值的降低与住院时间的延长独立相关，但与住院期间的死亡率无关。代谢性酸中毒与纤维蛋白原水平降低和 OLT 术中输血需求增加独立相关。了解这种关联可能会改善治疗策略，以降低 OLT 术中出血风险。
