The Correlation Between TEG And Liver Reserve Function In Cirrhosis And The Prediction Of Upper Gastrointestinal Bleeding

Objective: To study the correlation between Thromboelastography(TEG)and liver reserve function in patients with liver cirrhosis and its predictive value for upper gastrointestinal bleeding.Methods: 1.350 patients with liver cirrhosis who were hospitalized in Department of Gastroenterology,Shaanxi People's Hospital from January 2017 to May 2018 were selected as subjects.Child-Turcotte-Pugh(CTP)was evaluated by five indices of hepatic encephalopathy,ascites,total bilirubin,albumin and INR,and the model for End-stage Liver Disease(MELD)was calculated by four indices of total bilirubin,INR,creatinine and etiology.The two scoring systems were used to evaluate liver reserve function in patients with cirrhosis.According to CTP grading,cirrhosis patients were divided into Child-A group,Child-B group and Child-C group,and TEG parameters were compared among the three groups.At the same time,cirrhosis patients were divided into MELD-1group,MELD-2 group and MELD-3 group according to MELD score < 15,15-24,and <25.Spearman grade correlation analysis was used to compare the correlation between TEG parameters and CTP,MELD scores in 350 patients with liver cirrhosis.2.Patients with cirrhosis complicated with upper gastrointestinal bleeding were divided into bleeding group(104 cases)and non-bleeding group(246 cases).Clinical data(etiology,upper gastrointestinal bleeding history,portal vein thrombosis,endoscopic treatment history,splenectomy history),laboratory indicators(WBC,PLT,ALT,AST,CHE,TBIL,ALB,CRE,Na,PT,INR,APTT,Fg)and G parameters were analyzed.Univariate analysis,the indicators with statistical differences were included in unconditional logisticregression analysis,and the independent risk factors affecting upper gastrointestinal bleeding were obtained.The ROC curve was used to evaluate the predictive value of various factors for upper gastrointestinal bleeding in patients with cirrhosis.Results:1.With the increase of CTP grading,K value of TEG parameters was gradually prolonged,Angle,MA and CI were gradually shortened,and there was significant difference among the three groups(P < 0.05).The difference between Child-C group and Clid-B group was significant(P < 0.05).2.With the increase of MELD grouping,the R and K values of TEG parameters were gradually prolonged,while Angle,MA and CI were gradually shortened.There was a significant difference among the three groups(P < 0.05).The difference between MELD-2 group and MELD-1 group was significant(P < 0.05).3.R value was not correlated with CTP score(P > 0.05),but positively correlated with MELD score(r = 0.194,P < 0.05);K value was positively correlated with CTP and MELD score(r = 0.246,r = 0.194,all P < 0.05);Angle,MA,CI were negatively correlated with CTP and MELD score(r=-0.219,r=-0.242,r=-0.323,r=-0.322,r=-0.269,r=-0.313,all P < 0.05).4.History of upper gastrointestinal bleeding(?2 = 29.541,P < 0.01),history of endoscopic treatment(?2 = 13.347,P < 0.01),ALT(Z=-2.168,P < 0.05),AST(Z=-3.772,P < 0.05),TBIL(Z=-5.530,P < 0 05),APTT(Z=-2.318,P<0.05),Fg(t=2.756,P<0.05),R value(t=4.131,P<0.05),K value(t=-2.047,P<0.05)were all associated with cirrhosis complicated with upper gastrointestinal bleeding.5.History of upper gastrointestinal bleeding(OR = 2.748,95% CI: 1.624-4.648,P <0.001),the decrease of fibrinogen level(OR = 0.615,95% CI: 0.403-0.939,P = 0.024),the prolongation of K value(OR = 1.144,95% CI: 1.033-1.267,P = 0.010)were independent risk factors for upper gastrointestinal bleeding in cirrhosis.6.The area under ROC curve of upper gastrointestinal bleeding history and K value was [0.658(95% CI: 0.596-0.721),0.568(95% CI: 0.503-0.634)].The best critical valueof K value for predicting upper gastrointestinal bleeding in cirrhosis was 3.65 min,with sensitivity of 45.2% and specificity of 67.9%.Conclusions:1.The parameters of TEG are correlated with liver reserve function in patients with liver cirrhosis.With the decline of liver reserve function,R value and K value are gradually prolonged,while Angle,MA and CI are gradually shortened.2.History of upper gastrointestinal bleeding,decrease of fibrinogen level and prolongation of K value are independent risk factors for upper gastrointestinal bleeding in cirrhosis.3.K value of TEG parameters is the most valuable predictor of upper gastrointestinal bleeding in cirrhosis.