全血凝血酶生成受损与急性失代偿肝硬化手术相关出血有关。

IF 26.8 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Journal of Hepatology Pub Date : 2024-12-11 DOI:10.1016/j.jhep.2024.12.008

Alberto Zanetto, Elena Campello, Cristiana Bulato, Ruth Willems, Joke Konings, Mark Roest, Sabrina Gavasso, Giorgia Nuozzi, Serena Toffanin, Patrizia Burra, Francesco Paolo Russo, Marco Senzolo, Bas de Laat, Paolo Simioni

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引用次数: 0

摘要

背景,目的血栓调节素修饰凝血酶生成（TM-TG）在肝硬化中的临床应用尚不确定。我们进行了一项前瞻性研究来评估TM-TG在肝硬化中的预后价值。方法在门诊（代偿和稳定失代偿）或住院（急性失代偿，AD）期间招募患者。我们在招募时进行了全血（WB）和无血小板血浆（PPP） TM-TG检测。对所有患者进行了出血/血栓形成、肝脏失代偿和肝脏相关死亡的前瞻性随访。结果我们纳入了231例患者：80例代偿，70例稳定失代偿，81例AD。中位随访时间为414天（范围：77-668天）。11例AD患者均出现手术相关出血。出血组与非出血组相比，WB-TG和PPP-TG变化更大（内源性凝血酶电位[ETP]和峰高更低）。然而，只有WB-TG能够在患者个体水平上识别大出血患者（所有患者术前ETP均为350 nmol/L*min）。在AD患者中，WB-TG ETP诊断出血的ROC曲线下面积为0.854 (95%CI: 0.732-0.976)，高于PPP-TG ETP (0.676；95%置信区间:0.524—-0.809)。WB-TG和PPP-TG均不能预测血栓形成，主要是PVT （n=15）。在代偿性肝硬化中，WB-TG和PPP-TG在经历失代偿和未经历失代偿的患者之间具有可比性。在失代偿性肝硬化中，WB-TG和PPP-TG在进一步失代偿/ACLF/肝脏相关死亡的患者中发生更显著的改变。较高的WB-TG ETP与较低的进展风险相关，与MELD、Child-Pugh和c反应蛋白无关(HR: 0.4, 95% ci: 95%: 0.21-0.79；术中,0.01)。结论代偿性肝硬化、WB-TG和PPP-TG均不能改善风险分层。在失代偿性肝硬化中，WB-TG可能是评估手术相关出血风险的一个有前途的工具。试验注册号na

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Impaired whole blood thrombin generation is associated with procedure-related bleeding in acutely decompensated cirrhosis.

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Impaired whole blood thrombin generation is associated with procedure-related bleeding in acutely decompensated cirrhosis.

Background & Aims

The clinical utility of thrombomodulin-modified thrombin generation (TM-TG) in cirrhosis is uncertain. We conducted a prospective study to evaluate the prognostic value of TM-TG in cirrhosis.

Methods

Patients were recruited during outpatient clinics (compensated and stable decompensated) or if admitted to our inpatient service (acutely decompensated, AD). We performed whole blood (WB) and platelet-poor plasma (PPP) TM-TG at recruitment. All patients were prospectively followed-up for bleeding/thrombosis, hepatic decompensation, and liver-related death.

Results

We included 231 patients: 80 compensated, 70 stable decompensated, and 81 AD. Median follow-up was 414 days (range: 77-668). Eleven patients, all AD, experienced procedure-related bleeding. Both WB-TG and PPP-TG were more altered in bleeding vs. non-bleeding individuals (lower endogenous thrombin potential [ETP] and peak-height). However, only WB-TG could identify - at individual-patient level - those experiencing major bleeding (all having pre-procedural ETP <350 nmol/L*min). In AD, the area under the ROC curve of WB-TG ETP for bleeding was 0.854 (95%CI: 0.732-0.976), which was higher than that of PPP-TG ETP (0.676; 95%CI: 0.524-0.809). Neither WB-TG nor PPP-TG could predict development of thrombosis, mostly PVT (n=15). In compensated cirrhosis, WB-TG and PPP-TG were comparable between patients who experienced decompensation and those who did not. In decompensated cirrhosis, WB-TG and PPP-TG were more significantly altered in patients experiencing further decompensation/ACLF/liver-related death. A higher WB-TG ETP was linked to a lower risk of progression independently of MELD, Child-Pugh, and C-reactive protein (HR: 0.4, 95%CI: 95%: 0.21-0.79; p<0.01).

Conclusions

In compensated cirrhosis, WB-TG and PPP-TG do not improve risk stratification. In decompensated cirrhosis, WB-TG may be a promising tool for estimating procedure-related bleeding risk.

Trial registration number

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来源期刊

Journal of Hepatology 医学-胃肠肝病学

CiteScore

46.10

自引率

4.30%

发文量

2325

审稿时长

30 days

期刊介绍： The Journal of Hepatology is the official publication of the European Association for the Study of the Liver (EASL). It is dedicated to presenting clinical and basic research in the field of hepatology through original papers, reviews, case reports, and letters to the Editor. The Journal is published in English and may consider supplements that pass an editorial review.