Thromboelastography As A Predictor Of Short-term Outcomes In Patients With Severe Alcoholic Hepatitis

Objective:Alcoholic hepatitis(AH)is a clinical syndrome characterized by recent jaundice and liver inflammation.Severe alcoholic hepatitis(SAH)is a severe type of the disease,which can show the tendency of liver failure.SAH has a high short-term mortality rate.Because of the limited of using corticosteroids and poor therapeutic outcomes,liver transplantation is often the only effective treatment.The economic development and changing dietary habits caused the increasing burden of alcohol-related disease in China.The treatment of SAH is getting more and more attention.It is more and more urgent to evaluate the short-term outcome of SAH patients and screen out the clinical needs of patients who need emergency liver transplantation.Current molecular marker and prognostic scoring models forevaluating the prognosis still have some limitations.Thromboelastography(TEG)can dynamically assess the clot formation and evaluate the function of platelet function and coagulation.In this study,we analyzed the characteristics of thromboelastography(TEG@5000)parameter in SAH patients,to explore the effect of thromboelastogram on short-term outcome in patients with SAH.Methods:A total of 49 patients with SAH were attended in the Department of Hepatobiliary and Pancreatic Medicine of the First Hospital of Jilin University from November 2018 to November 2020 were enrolled.The basic information,laboratory date,TEG parameters,and imaging indices were collected to assess clinical characteristics and calculate prognostic scores,and their 28-and 90-day liver disease-related mortality and liver transplant-free survival were recorded at 90 days of follow-up.Statistical analysis was performed using IBM SPSS 26.0 software.Results:1.Analysis and characteristics of baseline TEG parameters in S AH patients:Thromboelastography parameters R-value averaged 6.3(5.3-7.2)min.K-value averaged 3.2(1.7-4.5)min.α angle averaged 57.5±13.4deg.MA averaged 43.5(34.7-50.5)mm.TEG parameters of SAH patients showed prolonged K-value.The TEG parameters of SAH patients showed hypocoagulation characteristics of prolonged K values,decreased MA.2.TEG parameters in the follow-up survival and death groups:ADP inhibition was 42.1(20.4-59.9)%in the 90-day survival group and 62.9(52.3-89.4)%in the 90-day death group inSAH patients.ADP inhibition was elevated in the 90-day death group,with a statistically significant difference(P=0.012).AA inhibition was 48.7(26.8-69.8)%in the 90-day survival group and 78.4(59.5-95.2)%in the 90-day death group.AA inhibition was elevated in the 90-day death group,with a statistically significant difference(P=0.004).3.Correlation analysis of TEG parameters and laboratory indicators:ADP inhibition was positively correlated with TBil(r=0.445,P=0.001),BUN(r=0.325,P=0.023),SCr(r=0.395,P=0.005)and negatively correlated with HDL-C(r=-0.4711,P=0.001).AA inhibition was positively correlated with TBil(r=0.472,P=0.001),SCr(r=0.309,P=0.031)and negatively correlated with HDL-C(r=-0.466,P=0.001)4.Correlation analysis between TEG parameters and prognostic scores:ADP inhibition was positively correlated with prognostic scores MDF(r=0.286,P=0.046),MELD(r=0.447,P=0.0001),MELD-Na(r=0.387,P=0.006),GAHS(r=0.321,P=0.024),ABIC(r=0.303,P=0.034),and CLIF-C OF(r=0.322,P=0.024).AA inhibition was positively correlated with prognostic scores MDF(r=0.280,P=0.051),MELD(r=0.446,P=0.0001),MELD-Na(r=0.372,P=0.008),GAHS(r=0.304,P=0.034),and CLIF-C OF(r=0.396,P=0.005).5.Analysis of SAH prognostic factors:Increased WBC、ANC、PLT、MPV、FIB、TBiL、SCr、BUN and decreased HDL-C、serum Na+ concentration in the 28-day mortality group(P<0.05).Increased WBC、ANC、TBiL、BUN and decreased HDL-C、serum Na+concentration in the 90-day mortality group(P<0.01).28-day death group had higher NLR and CLIF-C ACLF,MELD,MELD-Na,GAHS,and CLIF-C OF scores(P<0.05).90-day death group had higher MELD,MELD-Na,CLIF-C OF,CLIF-C ACLF,MDF,GAHS,ABIC,and NLR scores(P<0.01).6.One-way survival analysis of TEG parameters in SAH patients:The optimal cut-off values of ADP inhibition and AA inhibition were determined using ROC curves as 51.5%and 51.9%,respectively.The 90-day Kaplan-Meier curves of SAH patients were plotted using the cut-off values,and the ADP inhibition Log-rank test χ2=6.791,P=0.009;Breslow test χ2=6.278,P=0.012.AA inhibition Log-rank test χ2=7.361,P=0.007;Breslow test χ2=7.167,P=0.007.ADP and AA inhibition were predictors of 90-day outcome in SAH patients.7.Predictive value of TEG parameters for 90-day outcome in SAH patients:The ROC curve was plotted,and the ADP inhibition AUROC was 0.726 with 95%confidence interval of(0.580-0.844),sensitivity of 80.00%,specificity of 61.76%,and Yordon index of 0.4176.the AA inhibition AUROC was 0.759 with 95%confidence interval of(0.615-0.869),sensitivity of 86.67%,specificity was 58.82%,and Yordon index was 0.4549.In descending order of AUROC area,MELD(0.833),MELD-Na(0.832),CLIF-C ACLF(0.827),CLIF-C OF(0.809),GAHS(0.775),MDF(0.761),AA inhibition(0.759),ABIC(0.758),NLR(0.754),and ADP inhibition(0.726).AA inhibition predicted 90-day outcomes in SAH patients better than ADP inhibition,equivalent to MDF and ABIC scores.8.Analysis of TEG parameters in different subgroups of SAH patients:Patients with AKI had increased ADP inhibition(48.1%vs 64.7%,P<0.05)and increased AA inhibition(51.6%vs 80.3%,P<0.05)compared with patients without AKI.Compared with non-ALD-ACLF patients,ADP inhibition was elevated in ALD-ACLF patients(47.5%vs 59.2%,P<0.05)and AA inhibition(47.1%vs 79.4%,P<0.001).Conclusions:1.TEG parameters mainly showed hypocoagulation characteristics with prolonged K and decreased MA in SAH.2.AA inhibition was elevated in the 90-day death group of SAH patients,positively correlated with TBil and SCr,negatively correlated with HDL-C,and positively correlated with MDF,MELD,MELD-Na,GAHS,and CLIF-C OF prognostic scores.3.AA inhibition and ADP inhibition are related to the severity of SAH and can predict the 90-day outcome of SAH.4.AA inhibition and ADP inhibition were associated with the occurrence of AKI and ALD-ACLF.