Prediction Of Thromboelastography On Short-term Prognosis Of Patients With Acute On Chronic Liver Failure

Objective:ACLF is a severe type of clinical severe liver disease,often accompanied by multiple organ failure,a dangerous condition,a high short-term mortality rate,and a poor prognosis.Liver transplantation is the only effective treatment at present,but the source of liver is scarce and few people are treated.Therefore,early diagnosis and prediction of disease progression,screening of patients requiring emergency liver transplantation,and judging prognosis are important.At present,various biomarkers and prognostic models have been used in clinical practice to predict the prognosis of ACLF.However,due to various factors such as the etiology,the severity of underlying liver disease,and organ failure,there is a gap between the proposed serum markers and the prognostic evaluation system.There are still significant differences,and they all have certain limitations.In this study,a prospective observational cohort was established to analyze the characteristics of thromboelastometry(TEG5000)parameters in patients with ACLF,and to explore the correlation between thromboelastometry and short-term prognosis of ACLF.Methods:A total of 52 patients with ACLF who met the diagnostic criteria of Asian Pacific Association for the Study of the Liver(APASL)and were hospitalized in the Department of Hepatobiliary and Pancreatic Medicine of the First Hospital of Jilin University from October2018 to July 2019.The basic information,medical history,physical examination,admission laboratory examination and imaging examination were collected to judge the complications and the status of each organ failure,and the first thromboelastography was submitted for inspection within 3 days,and the clinical outcome was followed up for 28 days and 90 days.The date were analyed by SPSS 26.0 and drew with Graphpad prism software.Results:1.Analysis of thromboelastography parameters in ACLF patients:The ADP inhibition in the thromboelastography parameters was statistically significant in the comparison between the 28-day and 90-day survival and death groups of ACLF patients(P <0.05).Correlation analysis between ADP inhibition and biochemical indicators and prognosis scoring system found that: the ADP inhibition was positively correlated with INR,PT,APTT,WBC,SCr,MELD score,MELD-Na score,AARC score,CLIF-OF score,and CLIF-C ACLF score(P <0.05).2.Analysis of ADP inhibition on organ failure and mortality in patients with ACLF:Among the enrolled ACLF patients,the most common organ failure was liver failure(75.0%),followed by coagulation failure(34.6%).The patients were divided into 3 groups with ADP inhibition ≤ 30% and ≥ 70%,and the incidence of coagulation failure was statistically different between the three groups(P = 0.010).The incidence of coagulation failure was more high in ACLF patients with ADP inhibition ≥70%.Kaplan-Meier survival analysis was used to analyze the 90-day mortality of ACLF patients.The results showed that there were significant differences between the three groups.The P values between the groups were < 0.001.With the increase of the ADP inhibition,the 90-day mortality was increased.ACLF patients with ADP inhibition ≥70% had the worst prognosis.3.Analysis of ACLF prognostic factors:Comparison of 28-day and 90-day survival groups with death groups of ACLF patients:age,WBC,NLR,serum Na + concentration,ALB,CHE,AFP,MELD score,MELD-Na score,AARC-ACLF score,CLIF-C OF score,CLIF-C ACLF score were statistically significant(P <0.05).4.Analysis of the prognostic value of ADP inhibition on ACLF:The area under the ROC curve(AUC)of the 28-day and 90-day death risk of ACLF patients with ADP inhibition was 0.825 and 0.869,which were significantly higher than the MELD score(0.765,0.773),AARC score(0.686,0.750),and CLIF-C OFs(0.766,0.839).The scores were not significantly different from the MELD-Na score(0.878,0.869)andCLIF-C ACLF score(0.872,0.880)(P> 0.05).The area under the ROC curve(AUC)of ADP inhibition predicting the mortality of HBV-ACLF patients at 28 days and 90 days was 0.957 and 0.899,which were significantly higher than the MELD score(0.813,0.728),MELD-Na score(0.933、0.864)、AARC score(0.817,0.774),and CLIF-C ACLF score(0.933,0.832).The scores were comparable to the COSSH-ACLF score(0.967,0.902)(P> 0.05).5.Analysis of thromboelastography and complications of ACLF patients:In this study,30(57.7%)patients with ACLF had bacterial infection,compared with those without infection: thromboelastography parameters were not statistically significant(P> 0.05);16(30.8%)patients with ACLF had hepatic encephalopathy,compared with patients without hepatic encephalopathy: K value,MA,ADP inhibition,and AA inhibition were statistically significant(P <0.05);11(21.2%)patients with ACLF had acute kidney injury,compared with patients without acute kidney injury: R value,ADP inhibition,AA inhibition were statistically significant(P <0.05).Conclusions:1.Thromboelastography parameter ADP inhibition varies greatly in ACLF patients at28 and 90 days with different prognosis groups,and is positively correlated with INR,PT,APTT,WBC,SCr,MELD score,MELD-Na score,AARC score,CLIF-OF score,and CLIF-C ACLF score.2.Platelet dysfunction is a new type of organ damage in ACLF,and the ADP inhibition can be used as a suitable layering cutoff for new types of organ damage(≤30%,30%-70%,≥70%).3.This study found that ADP inhibition has a good clinical predictive value for the short-term mortality risk of ACLF,especially for hepatitis B-related ACLF,which is a new marker for ACLF.4.Thromboelastography parameters are related to the occurrence of hepatic encephalopathy and acute kidney injury in patients with ACLF.