| Objective:At present,it is generally believed that patients with liver cirrhosis are in a state of "rebalance of bleeding and coagulation".Traditional coagulation tests cannot accurately reflect the risk of bleeding and coagulation in patients with liver cirrhosis.TEG,as a test that can detect the coagulation status of whole blood,has gradually been widely used in liver disease.The aim of this study is to investigate the value of TEG parameters in predicting coagulation events and prognosis in HBV-related ACLF patients.Methods:A total of 185 patients diagnosed with cirrhosis and HBV-related ACLF in the Department of Infectious Diseases of the First Affiliated Hospital of Nanchang University from January 2020 to July 2022 were enrolled.The basic clinical data,baseline TEG parameters within 3 days after admission,bleeding and thrombotic events during hospitalization,and 90-day clinical outcomes were collected.The patients were divided into bleeding group(45 cases)and non-bleeding group(140cases)according to the presence or absence of bleeding events.The bleeding group was further divided into variceal bleeding group(22 cases)and non-variceal bleeding group(23 cases)according to the cause of bleeding.According to the presence or absence of thrombosis,the patients were divided into thrombosis group(16 cases)and non-thrombosis group(169 cases).The predictive value of TEG in predicting bleeding and thrombotic events in ACLF patients with liver cirrhosis was analyzed,and the risk factors for bleeding were evaluated.According to the 90-day prognosis,the patients were divided into survival group(125 cases)and death group(60 cases),and the prognostic value of TEG parameters was analyzed.Results:1.The general clinical characteristics and TEG parameters of the enrolled patients: the patients were mainly male(81.1%),the average MELD score was19.8±6.4,37 patients(22.2%)were Child-Pugh grade B,and 148 patients(77.8%)were Child-Pugh grade C.The most common previous abdominal surgery was endoscopic variceal therapy(5.4%),and the most common invasive procedure during hospitalization was abdominal paracentesis(58.4%).The baseline MA was decreased in 111 patients(60.0%),within the reference range in 71 patients(38.4%),and increased in 3 patients(1.6%).CI decreased in 87 cases(47.0%),within the reference range in 94 cases(50.8%),and increased in 4 cases(2.2%).G decreased in 100 cases(54.1%),within the reference range in 80 cases(43.2%),and increased in 5 cases(2.7%).Most of the remaining values of R,K,Angle,EPL and LY30 were within the reference range.2.K,Angle,MA,EPL,LY30,CI and G of TEG parameters all have certain predictive value for bleeding events in ACLF patients with hepatitis B cirrhosis,but the predictive value is small(AUC < 0.7).MA and G values have great predictive value for non-venous related bleeding(AUC > 0.7).The AUC value of maximum amplitude MA for predicting non-variceal bleeding was 0.714,and the optimal cut-off point was 41.1mm,the difference was statistically significant(P=0.001),and the sensitivity was 71.4%,The specificity was 65.2%.The AUC value of clot strength G for predicting non-variceal bleeding was 0.714,and the optimal cut-off point was3490d/sc,with a statistically significant difference(P=0.001),and the sensitivity was65.2%.The specificity was 71.4%.Combined renal injury(OR=4.980,95%CI2.254-11.007,P < 0.001),Angle < 56.75deg(OR=4.057,95%CI 1.933-10.193,P<0.001)were the independent risk factors for predicting bleeding in ACLF patients with HBV-related liver cirrhosis.3.There were no significant differences in TEG parameters and traditional coagulation parameters between the thrombosis group and the non-thrombosis group(P > 0.05).4.The response time R in TEG parameters had a certain predictive value for the90-day prognosis of patients(AUC=0.619),and the best cut-off point was 4.95 min,the difference was statistically significant(P=0.009),and the sensitivity was 80.0%,The specificity was 38.4%,and the predictive value was lower than that of PT(AUC=0.699)and MELD score(AUC=0.808).The number of patients who died within 90 days in the reaction time R > 4.95 min group was 48,and the mortality rate was 38.4%.The P values of Log-Rank test and Breslow test were 0.012 and 0.008,respectively,which could predict the 90-day mortality outcome of ACLF patients with hepatitis B cirrhosis.Conclusions:1.The TEG parameters of ACLF patients with HBV-related liver cirrhosis showed hypocoagulation characteristics with reduced maximum amplitude(MA),comprehensive coagulation index(CI)and blood clot intensity(G)compared with normal reference values.2.The TEG parameters such as K,Angle,MA,EPL,LY30,CI and G all have certain predictive value for bleeding events in ACLF patients with hepatitis B cirrhosis,but the predictive value is small.MA and G values have greater predictive value for non-venous related bleeding events.Renal injury and Angle < 56.75 deg are independent risk factors for predicting bleeding in ACLF patients with hepatitis B cirrhosis.3.Neither TEG parameters nor traditional coagulation parameters can predict thrombotic events in ACLF patients with HBV-related liver cirrhosis.4.The response time R in TEG parameters has a certain predictive value for the90-day prognosis of patients,but the predictive value is lower than that of PT and MELD score.The response time R > 4.95 min can predict the 90-day death outcome of ACLF patients with hepatitis B cirrhosis. |
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