Evaluation Of The Progress Of Liver Cirrhosis And The Study Of The Blood Transfusion Therapy By Thromboelastography

BackgroundLiver is the most important organ in the coagulation system.When severe liver disease occurs,decreased of coagulation and anticoagulants,liver failure,portal hypertension,and thrombocytopenia can all lead to coagulation disorders in the human body and increase the risk of bleeding or thrombosis.Prothrombin time(PT)and international normalized ratio(INR)are often used as standards for the evaluation of the coagulation function and the classification in patients with liver cirrhosis.However,these indicators have certain limitations.In recent years,thrombelastogram(TEG)has developed rapidly as a fast and convenient technology to understand the full picture of patients’ coagulation,and it has become a clinical assessment method for the complex coagulation status of patients with liver cirrhosis.However,there is currently no detailed study on the correlation between TEG indicators and the severity of patients with liver cirrhosis,and TEG has no clear guidance on the blood transfusion treatment of patients with liver cirrhosis.Object1.To understand the application of TEG in patients with liver cirrhosis by analyzing the correlation between TEG and related coagulation indexes;to study the changes of TEG and related indexes in patients with liver cirrhosis at different stages,and to explore its evaluation value in the progress of liver cirrhosis.2.To study the predictive value of thromboelastography in the diagnosis of coagulation disorders in patients with liver cirrhosis,so as to understand the guiding role of TEG in the treatment of liver cirrhosis and its complications.To study the predictive value of TEG in the blood transfusion in patients with coagulation disorders in liver cirrhosis,so as to understand its guiding role in the blood transfusion in liver cirrhosis.MethodsThis study collected 346 diagnosed patients who were admitted to the Department of Infectious Diseases and Gastroenterology Department of Shantou Central Hospital from May2019 to August 2020 and met the diagnostic criteria for liver cirrhosis and excluded combined known coagulation disorders,acute liver failure,recent use of blood products or anticoagulation therapy.They were divided into A,B,C and D according to MELD score.To analyze the correlation between TEG and coagulation indexes and the changes of related indexes in the progression of cirrhosis,the parameters of thromboelastography(including R,K,α,MA,CI),routine coagulation function(including PT,APTT,FIB,TT,D-D),factor X,antithrombin III,platelet count,total bilirubin,creatinine,prealbumin,cholinesterase and other indicators were observed in the four groups at different stages of progression.The predictive effect of TEG on the occurrence of coagulation disorders in patients with cirrhosis was understood by receiver operating characteristic curve(ROC),area under curve(AUC)and Youden index.Multiple linear regression analysis was conducted to explore the guiding significance of TEG for blood transfusion treatment of coagulation disorders in patients with cirrhosis.Results:1.Correlation analysis of TEG parameters with coagulation indexes.K value was negatively correlated with FIB,ATⅢ,FX and PLT(r=-0.421,-0.578,-0.505,-0.512,P<0.05);αvalue was positively correlated with FIB,ATⅢ,FX,PLT(r=0.427,0.574,0.582,0.445,P<0.05);MA value was positively correlated with FIB,ATⅢ,FX,PLT(r=0.593,0.663,0.522,0.716,P<0.05);CI value was positively correlated with FIB,ATⅢ,FⅩ,PLT(r=0.420,0.636,0.605,0.517,P<0.05).2.Evaluation of TEG parameters on the progress of liver cirrhosis.(1)PT,APTT and TT were gradually prolonged in MELD score group A,B,C and D(P<0.05);D-D did not show obvious regularity in the progress of liver cirrhosis(P>0.05);FIB,PLT,ATⅢ and FX were gradually decreased in MELD score group A,B,C and D(P<0.05);in the biochemical indexes related to liver function,total bilirubin and creatinine were significantly decreased in MELD score group A,B,C and D(P<0.05).The level of cholinesterase and prealbumin in MELD score group A,B,C and D decreased gradually(P<0.05).(2)In TEG parameters,K value in MELD score group A,B,C and D gradually prolonged(P<0.05);α value,MA value and CI value in MELD score group A,B,C and D gradually decreased(P<0.05);R value did not increase or decrease with the increase of MELD score,and showed no obvious regularity in the progress of liver cirrhosis(P>0.05).(3)In TEG parameters,K value was positively correlated with MELD score(r=0.413,P<0.05);α value,Ma value and CI value were negatively correlated with MELD score(r=-0.323,-0.515,-0.384,P<0.05).There was no significant correlation between R value and MELD score(P>0.05).3.Liver cirrhosis patients with coagulation disorders have more severe low clotting status than non coagulation disorders.In TEG,the AUC value of MA in predicting the occurrence of coagulation disorders in patients with cirrhosis is highest(AUC=0.712,P<0.05),and followed by CI(AUC=0.620,P<0.05).The optimal cut-off values of TEG in the diagnosis of coagulation disorders in liver cirrhosis were R>5.1min,K>5.6min,α<43.5°,MA<37.2mm,CI<6.5.When MA<37.2,the sensitivity,specificity,positive predictive value,and negative predictive value of MA were 60.3%,80.8%,65.0%,and 76.9%,respectively(P<0.05);when CI<6.5,the sensitivity,specificity,positive predictive value,and negative predictive value of CI were 37.4%,91.5%,72.1%,and 69.9%,respectively(P<0.05).4.The blood transfusion group had more severe low clotting status than the non blood transfusion group.All the parameters in TEG are the influencing factors of patients with cirrhosis and coagulopathy,which can explain 56.3% of the total variation(P=0.015),and the regression coefficient(B)of CI is the highest(B=-1.257,95%CI:-2.03～-0.511,P=0.009);R,α,MA,and CI in TEG are the influencing factors of platelet transfusion in patients with cirrhosis and coagulopathy(P<0.05),and can explain 47.4% of the total variation(P=0.003),of which the regression coefficient(B)of MA is the highest(B=-0.853,95%CI:-1.065～-0.641,P=0.029).ConclusionTo some extent,TEG can be used as a marker of the progress of liver cirrhosis;TEG can be combined with related coagulation test,liver function related biochemical indicators to evaluate the severity of liver cirrhosis.MA<37.2,CI<-6.5 can be used as the diagnostic threshold of coagulation disorders in liver cirrhosis.CI has the greatest guiding significance for the viral inactivated plasma infusion in patients with cirrhosis and coagulopathy,and MA has the greatest guiding significance for the platelet infusion.