Correlation Analysis And Clinical Application Of Thrombelastography(TEG) And Conventional Coagulation Tests In Malignant Tumor Patients

Objective: To investigate the value of thrombelastography(TEG) in determing the function of blood coagulation among patients with malignant tumor.Methods: We prospectively collected 339 cases of malignant tumor in The Military General Hospital of Beijing from November 2014 to September 2015,whose demographics,results of TEG, conventional coagulation tests(CCTs) and platelet counts of 339 were comprehensively analyzed for their correlation, Kappa identity and regression. The major observation indexes respectively were PT、APTT、FIB、D-D、R、K、Angle、MA and PLT. The sensitivity and specificity of TEG,CCTs and the combined detection of them to predict the incidence of thrombosis in malignant tumor patients were also evaluated.Results: 1.We statistically analysised all 339 cases, including 208 males and 131 females. The ratio of males to females was 1.59 to 1,and the median age was 58 years. Among them 104 cases suffered lung cancer,176 gastrointestinal malignancies,20 breast cancer,20 genital system tumor and 19 other system cancer,21 cases with thrombosis. 2.The TEG R time was positively correlated to activated partial thromboplastin time(APTT)( r=0.365,p<0.001),but not to plasma prothrombin time(PT)(r=0.058, p=0.285). The shortening of R time and APTT suggested high haemostatic activity; The prolonging of R time and APTT suggested deficiency of coagulation factor. The TEG K value was negatively correlated to fibrinogen(FIB) and plateletcount(PLT)(r=-0.558、p<0.001,r=-0.505、p<0.001),Angle was positively correlated to fibrinogen and platelet count(r=0.54、 p<0.001,r=0.483、 p<0.001),MA was positively correlated to fibrinogen and platelet count(r=0.668、p<0.001,r=0.702、p<0.001). The decrease of K value and the increase of Angle, MA,FIB and PLT value suggested that the patients have high levels of fibrinogen and strong function of platelet. The increase of K value and the decrease of Angle, MA,FIB and PLT value suggested patients’ low levels of fibrinogen and weak function of platelet. R time was positively correlated to K value(r=0.542、p<0.001),MA was positively correlated to Angle(r=0.793、p<0.001).Angle was negatively correlated to K value(r=-0.985、p<0.001), the same result were obtained between MA and K value(r=-0.828、p<0.001), Angle and R time(r=-0.598、p<0.001), MA and R time(r=-0.256、p<0.001).The decrease of R time and K value, together with the increase of Angle and MA value suggested patients have high haemostatic activity,high levels of fibrinogen and strong function of platelet; Enhancing R time and K value, and declining Angle and MA value suggested patients have reducing coagulation factor and primary levels of fibrinogen,and poor function of platelet. By multiple regression, R time was only influenced by APTT.APTT represents the activity of endogenous coagulation factor. So R time mainly reflects the function of endogenous coagulation factor. Angle, K and MA value were influenced by APTT, FIB, PLT, all of which are parameters of routine assay. So Angle, K and MA value were mainly influenced by coagulation factor, fibrinogen and platelet. 3.Although MA was significantly correlated with PLT, individuals with the higher MA values corresponded with a diverse numbers of PLT. 4.The Kappa values of the TEG R time with APTT and PT reflecting the haemostatic activity were 0.034(p>0.05)and 0.015(p>0.05) respectively. The consistency between R time and APTT and PT were inferior. The Kappa analysis show statistically significant consistency between The TEG K value, Angle, MA and FIB reflecting the level of fibrinogen(p<0.001, with a Kappa value of 0.253, 0.365, 0.43 respectively).The Kappa values between the TEG K value, Angle, MA and PLT reflecting the function of platelet were 0.286, 0.244, 0.413 respectively, which were also significant different(p<0.001).The TEG K value, Angle, MA were consistent with FIB, PLT. TEG and CCTs, which indicated that both two tests had moderate consistency in reflecting the fibrinogen and platelet. 5. Among the 21 cases with thrombosis, TEG 、CCTs and combination reflected hypercoagulable state respectively were 12 cases、4 cases and 13 cases.The sensitivity and specificity of TEG,CCTs and the combination of them to predict the incidence of thrombosis in malignant tumor patients were 57%, 19%, 62% and 49%,56%,46% respectively. Regarding prediction in tumor patients with thrombus, the sensitivity from high to low in turn was combination, TEG and CCTs, and the specificity of them was similar.Conclusion: It demonstrates a significant correlation and consistency between the results of TEG and CCTs, but the goodness of fit was general. There was significant difference between TEG and CCTs, so they can not replace each other.