Assessment of hemostatic profile in patients with mild to advanced liver cirrhosis  

作　　者：Elisabeth Hannah Adam Madara Mohlmann Eva Herrmann Sonia Schneider Kai Zacharowski Stefan Zeuzem Christian Friedrich Weber Nina Weiler 

机构地区：[1]Department of Anaesthesiology,Intensive Care Medicine and Pain Therapy,University Hospital Frankfurt,Goethe-University Frankfurt,Frankfurt 60590,Germany [2]Department of Biostatistics and mathematical modeling,University Hospital Frankfurt,Goethe-University Frankfurt,Frankfurt 60590,Germany [3]Department of Internal Medicine,Division of Gastroenterology and Hepatology,University Hospital Frankfurt,Goethe-University Frankfurt,Frankfurt 60590,Germany [4]Department of Anaesthesiology,Intensive Care Medicine and Emergency Medicine,Asklepios Clinics Hamburg,Hamburg 22043,Germany

出　　处：《World Journal of Gastroenterology》2020年第17期2097-2110,共14页世界胃肠病学杂志（英文版）

摘　　要：BACKGROUND Hemostasis of patients suffering from liver cirrhosis is challenging due to both,pro-and anticoagulatory disorders leading to hemostatic alterations with distinct abnormalities of coagulation.Pathological changes in conventional coagulation analysis and platelet count are common manifestations of decreased liver synthesis of coagulation factors and reduced platelet count in these patients.However,conventional coagulation analysis and platelet count do not reflect invivo coagulation status or platelet function.The purpose of this present observational study was therefore to assess the haemostatic profile including plasmatic coagulation using thrombelastometry and impedance aggregometry for platelet function in patients suffering from liver cirrhosis.AIM To assess the hemostatic profile of cirrhotic patients according to model for endstage liver disease(MELD)score.METHODS Our study included both in-and outpatients suffering from liver cirrhosis attending the out-and inpatient care of the department of hepatology.Demographic and biochemical data as well as medical history including cause of liver cirrhosis,end stage kidney failure and medication with anticoagulants were recorded.To assess the hemostatic profile,platelet function was analyzed by multiple electrode aggregometry(MEA)using Multiplate^■(ADP-,ASPI-and TRAP-test)and thrombelastometry using ROTEM^■(EXTEM,INTEM,FIBTEM).Data were compared using Mann-Whitney U-or χ^2-test.Spearman correlation was performed to analyze the association between MELD Score and results of thrombelastometry and MEA.RESULTS A total of 68 patients attending the out-and inpatient care suffering from liver cirrhosis were screened.Of these,50 patients were included and assigned to groups according to MELD score 6 to 11(n=25)or≥17(n=25).Baseline patient characteristics revealed significant differences for MELD score(8 vs 22,P<0.0001)and underlying laboratory parameters(international normalized ratio,bilirubine,creatinine)as well as fibrinogen level(275 mg/dL vs 209 mg/dL,

关 键 词：LIVER cirrhosis Model for END-STAGE LIVER disease COAGULOPATHY Multiple electrode AGGREGOMETRY Thrombelastometry HEMOSTASIS 

分 类 号：R575.2[医药卫生—消化系统]