Ruhail Kohli1, Alexandra Shingina2,3, Stephen New4, Shruti Chaturvedi5, Alexander Benson6, Scott W Biggins2,3, Kiran Bambha7,8. 1. Division of Gastroenterology and Hepatology, Johns Hopkins Bayview Medical Center, The Johns Hopkins University School of Medicine, 4940 Eastern Avenue, Baltimore, MD, 21224, USA. 2. Division of Gastroenterology and Hepatology, University of Washington Medical Center, University of Washington, 1959 NE Pacific Street, Box 356175, Seattle, WA, 98195, USA. 3. Hepatology and Liver Transplantation, Center for Liver Investigation Fostering discovEry (C-LIFE), University of Washington Medical Center, University of Washington, 1959 NE Pacific Street, Box 356175, Seattle, WA, 98195, USA. 4. Division of Gastroenterology, Denver Digestive Health Specialists, Rose Medical Center, 4500 East 9th St Ste 720S, Denver, CO, 80220, USA. 5. Division of Hematology, Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, 720 Rutland Ave, Room 1032, Baltimore, MD, 21205, USA. 6. Critical Care, Pulmonary, and Sleep Associates, 274 Union Blvd, Lakewood, CO, 80228, USA. 7. Division of Gastroenterology and Hepatology, University of Washington Medical Center, University of Washington, 1959 NE Pacific Street, Box 356175, Seattle, WA, 98195, USA. kbambha@medicine.washington.edu. 8. Hepatology and Liver Transplantation, Center for Liver Investigation Fostering discovEry (C-LIFE), University of Washington Medical Center, University of Washington, 1959 NE Pacific Street, Box 356175, Seattle, WA, 98195, USA. kbambha@medicine.washington.edu.
Abstract
BACKGROUND: Coagulopathy in cirrhosis represents complex coagulation derangements, and thromboelastography (TEG) measures these complex derangements. AIM: We sought to evaluate associations between TEG parameters and validated measures of cirrhosis severity, which have not been previously investigated. MATERIALS AND METHODS: Adults with cirrhosis undergoing liver transplant (LT) were identified. Patients had TEG drawn immediately prior to LT. TEG parameters included reaction time (R), kinetic time (K), alpha angle (α), and maximum amplitude (MA). The validated measures of cirrhosis severity were MELD-Na and clinical stage of cirrhosis (classified using history of varices, variceal bleeding, or ascites). Multivariable linear and logistic regression analyses were conducted to evaluate the associations between TEG and stage of cirrhosis and MELD-Na. RESULTS: Among 164 patients with cirrhosis, advancing stage of cirrhosis was associated with more hypocoagulable TEG parameters including longer K-time (p = 0.05) and lower MA (p < 0.001). Similarly, with increasing MELD-Na quartiles, K-time was longer (p < 0.001), and both MA and α-angle decreased (p < 0.001, for both). Variceal bleeding within 6 weeks prior to LT was associated with longer R-times (p = 0.02), longer K-times (p = 0.04), smaller α-angle (p = 0.03), and lower MA (p = 0.01). On multivariable analyses, decreasing MA remained statistically significantly associated with advancing stage of cirrhosis and increasing MELD-Na, after adjusting for multiple covariates including platelet count, (p = 0.02 and p < 0.0001, respectively). CONCLUSIONS: Hypocoagulable TEG measurements are associated with advancing stage of cirrhosis and increasing MELD-Na among patients with cirrhosis. These data indicate that TEG, as an informative measure of complex hemostatic function, may be a useful objective marker of liver disease severity in cirrhosis.
BACKGROUND:Coagulopathy in cirrhosis represents complex coagulation derangements, and thromboelastography (TEG) measures these complex derangements. AIM: We sought to evaluate associations between TEG parameters and validated measures of cirrhosis severity, which have not been previously investigated. MATERIALS AND METHODS: Adults with cirrhosis undergoing liver transplant (LT) were identified. Patients had TEG drawn immediately prior to LT. TEG parameters included reaction time (R), kinetic time (K), alpha angle (α), and maximum amplitude (MA). The validated measures of cirrhosis severity were MELD-Na and clinical stage of cirrhosis (classified using history of varices, variceal bleeding, or ascites). Multivariable linear and logistic regression analyses were conducted to evaluate the associations between TEG and stage of cirrhosis and MELD-Na. RESULTS: Among 164 patients with cirrhosis, advancing stage of cirrhosis was associated with more hypocoagulable TEG parameters including longer K-time (p = 0.05) and lower MA (p < 0.001). Similarly, with increasing MELD-Na quartiles, K-time was longer (p < 0.001), and both MA and α-angle decreased (p < 0.001, for both). Variceal bleeding within 6 weeks prior to LT was associated with longer R-times (p = 0.02), longer K-times (p = 0.04), smaller α-angle (p = 0.03), and lower MA (p = 0.01). On multivariable analyses, decreasing MA remained statistically significantly associated with advancing stage of cirrhosis and increasing MELD-Na, after adjusting for multiple covariates including platelet count, (p = 0.02 and p < 0.0001, respectively). CONCLUSIONS: Hypocoagulable TEG measurements are associated with advancing stage of cirrhosis and increasing MELD-Na among patients with cirrhosis. These data indicate that TEG, as an informative measure of complex hemostatic function, may be a useful objective marker of liver disease severity in cirrhosis.
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