Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an City, Shaanxi Province, China.
Department of Anesthesiology, The Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen City, People's Republic of China.
Singapore Med J. 2024 Aug 1;65(8):438-443. doi: 10.4103/singaporemedj.SMJ-2021-404. Epub 2023 Apr 13.
Thromboelastography (TEG) provides a global assessment of haemostasis and is potentially applicable to liver disease. The present study aimed to explore the utility of TEG for the evaluation of patients with chronic viral liver disease, which has previously not been investigated.
Demographic characteristics and TEG parameters were collected before surgery. Child-Turcotte-Pugh (CTP) and model for end-stage liver disease (MELD) scores were used to categorise stages of liver cirrhosis. Liver resections were classified as low, medium and high complexity.
A total of 344 patients were included. Results showed significantly longer K-time, smaller α-angle and lower maximum amplitude (MA) with increasing liver disease severity as measured by the CTP and MELD scores ( P < 0.05 for all). After multivariable adjustment (including age, sex, liver disease aetiology, alanine aminotransferase [ALT], aspartate aminotransferase [AST], albumin, total bilirubin, haemoglobin and platelet count), TEG parameters (except R-times) were either weakly or inversely related to the severity of liver disease as defined by the MELD score (absolute r < 0.2 and P < 0.05 for all except R-times). R-times obtained before surgery were weakly correlated with perioperative blood loss ( r < 0.2 and P < 0.05 for all).
The correlation between TEG parameters and severity of liver disease was weak. In addition, R-times obtained before liver resection were weakly associated with perioperative blood loss after multivariable adjustments. TEG utility for haemostasis assessment and prediction of blood loss during liver resection should be further explored in high-quality studies.
血栓弹力图（TEG）可全面评估止血功能，且可能适用于肝脏疾病。本研究旨在探索 TEG 用于评估慢性病毒性肝病患者的效用，而此前尚未对此进行研究。
收集手术前的人口统计学特征和 TEG 参数。采用 Child-Turcotte-Pugh（CTP）和终末期肝病模型（MELD）评分对肝硬化阶段进行分类。肝切除术分为低、中、高复杂程度。
共纳入 344 例患者。结果显示，随着 CTP 和 MELD 评分评估的肝脏疾病严重程度增加，K 时间延长，α角减小，最大振幅（MA）降低（所有 P 值均<0.05）。经过多变量调整（包括年龄、性别、肝脏疾病病因、丙氨酸氨基转移酶[ALT]、天冬氨酸氨基转移酶[AST]、白蛋白、总胆红素、血红蛋白和血小板计数）后，TEG 参数（除 R 时间外）与 MELD 评分定义的肝脏疾病严重程度呈弱相关或负相关（绝对值 r<0.2，所有 P 值均<0.05，除 R 时间外）。手术前获得的 R 时间与围手术期出血量呈弱相关（所有 r<0.2，P<0.05）。
TEG 参数与肝脏疾病严重程度的相关性较弱。此外，肝切除术前获得的 R 时间在多变量调整后与围手术期出血量弱相关。TEG 在评估肝切除术中止血和预测失血方面的效用应在高质量研究中进一步探索。
