Abstract
BackgroundPatients with liver cirrhosis typically exhibit abnormal coagulation parameters in conventional coagulation tests (CCTs). Rotational thromboelastometry (ROTEM) is a holistic blood coagulation assay. This method provides an insight into the global hemostatic capabilities and has been suggested to provide a better overview of the coagulation system in liver cirrhosis.MethodsThe goal of this study was to examine hemostasis in patients with stable liver cirrhosis (Non-ACLF) and in acute-on-chronic liver failure (ACLF) by CCT and ROTEM including agreement of both tests and the prospective assessment of test performance based on clinical outcomes in ACLF patients. Therefore, ACLF patients were additionally subgrouped by bleeding events. Fifty-five Non-ACLF patients and twenty-two patients with ACLF were analysed in this prospective cohort study.ResultsCoagulation parameters analysed by CCT were outside the normal range in Non-ACLF and ACLF patients, but were significantly more aberrant in ACLF patients. Non-ACLF patients analysed by ROTEM revealed parameters largely within the normal limits, while significantly more ROTEM parameters in ACLF patients were affected. Maximum clot firmness (MCF) was significantly divergent between both patient groups and correlated well with levels of fibrinogen and platelet count. Using Cohen’s Kappa coefficient κ, the strength of agreement between CCT and ROTEM analyses was determined to be fair for Non-ACLF patients and moderate for ACLF patients. Bleeding events occurred significantly more often in ACLF group with significantly reduced A10 and MCF.ConclusionsFor assessing hemostasis in Non-ACLF and ACLF patients the underlying dataset shows advantages of ROTEM over CCT. A10 and MCF represent suitable prognostic parameters in predicting bleeding events in ACLF group.
Highlights
Patients with liver cirrhosis typically exhibit abnormal coagulation parameters in conventional coagulation tests (CCTs)
We further examined the strength of agreement between CCT and Rotational thromboelastometry (ROTEM) in Non-Acute-on-chronic liver failure (ACLF) and ACLF patients and assessed prospectively the test performance based on clinical outcomes in ACLF patients
Age and gender were distributed between Non-ACLF and ACLF liver cirrhosis patients
Summary
Patients with liver cirrhosis typically exhibit abnormal coagulation parameters in conventional coagulation tests (CCTs). Rotational thromboelastometry (ROTEM) is a holistic blood coagulation assay This method provides an insight into the global hemostatic capabilities and has been suggested to provide a better overview of the coagulation system in liver cirrhosis. The commonly occurring laboratory findings corresponding to this alteration of hemostasis in cirrhotic patients are raised INR, prolonged aPTT and thrombocytopenia. These measurements are being questioned for their ability to correctly represent the in vivo hemostatic state of cirrhotic patients [1]. Samples for INR and aPTT measurements are being centrifuged and consist solely of a patient’s serum This results in a lack of representation of the cellular parts of coagulation in these assays. In patients with liver cirrhosis, the loss of pro-hemostatic drivers is balanced by the loss of anti-hemostatic processes
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