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Thromboelastometry: Relation to the severity of liver cirrhosis in patients considered for liver transplantation

The severity of liver disease is assessed by scoring systems, which include the conventional coagulation test prothrombin time-the international normalized ratio (PT-INR). However, PT-INR is not predictive of bleeding in liver disease and thromboelastometry (ROTEM) has been suggested to give a bette...

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Autores principales: Dumitrescu, Gabriel, Januszkiewicz, Anna, Ågren, Anna, Magnusson, Maria, Wahlin, Staffan, Wernerman, Jan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5466232/
https://www.ncbi.nlm.nih.gov/pubmed/28591054
http://dx.doi.org/10.1097/MD.0000000000007101
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author Dumitrescu, Gabriel
Januszkiewicz, Anna
Ågren, Anna
Magnusson, Maria
Wahlin, Staffan
Wernerman, Jan
author_facet Dumitrescu, Gabriel
Januszkiewicz, Anna
Ågren, Anna
Magnusson, Maria
Wahlin, Staffan
Wernerman, Jan
author_sort Dumitrescu, Gabriel
collection PubMed
description The severity of liver disease is assessed by scoring systems, which include the conventional coagulation test prothrombin time-the international normalized ratio (PT-INR). However, PT-INR is not predictive of bleeding in liver disease and thromboelastometry (ROTEM) has been suggested to give a better overview of the coagulation system in these patients. It has now been suggested that coagulation as reflected by tromboelastomety may also be used for prognostic purposes. The objective of our study was to investigate whether thrombelastometry may discriminate the degree of liver insufficiency according to the scoring systems Child Pugh and Model for End-stage Liver Disease (MELD). Forty patients with chronic liver disease of different etiologies and stages were included in this observational cross-sectional study. The severity of liver disease was evaluated using the Child-Pugh score and the MELD score, and blood samples for biochemistry, conventional coagulation tests, and ROTEM were collected at the time of the final assessment for liver transplantation. Statistical comparisons for the studied parameters with scores of severity were made using Spearman correlation test and receiver-operating characteristic (ROC) curves. Spearman correlation coefficients indicated that the thromboelastometric parameters did not correlate with Child-Pugh or MELD scores. The ROC curves of the thromboelastometric parameters could not differentiate advanced stages from early stages of liver cirrhosis. Standard ROTEM cannot discriminate the stage of chronic liver disease in patients with severe chronic liver disease.
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spelling pubmed-54662322017-06-15 Thromboelastometry: Relation to the severity of liver cirrhosis in patients considered for liver transplantation Dumitrescu, Gabriel Januszkiewicz, Anna Ågren, Anna Magnusson, Maria Wahlin, Staffan Wernerman, Jan Medicine (Baltimore) 3300 The severity of liver disease is assessed by scoring systems, which include the conventional coagulation test prothrombin time-the international normalized ratio (PT-INR). However, PT-INR is not predictive of bleeding in liver disease and thromboelastometry (ROTEM) has been suggested to give a better overview of the coagulation system in these patients. It has now been suggested that coagulation as reflected by tromboelastomety may also be used for prognostic purposes. The objective of our study was to investigate whether thrombelastometry may discriminate the degree of liver insufficiency according to the scoring systems Child Pugh and Model for End-stage Liver Disease (MELD). Forty patients with chronic liver disease of different etiologies and stages were included in this observational cross-sectional study. The severity of liver disease was evaluated using the Child-Pugh score and the MELD score, and blood samples for biochemistry, conventional coagulation tests, and ROTEM were collected at the time of the final assessment for liver transplantation. Statistical comparisons for the studied parameters with scores of severity were made using Spearman correlation test and receiver-operating characteristic (ROC) curves. Spearman correlation coefficients indicated that the thromboelastometric parameters did not correlate with Child-Pugh or MELD scores. The ROC curves of the thromboelastometric parameters could not differentiate advanced stages from early stages of liver cirrhosis. Standard ROTEM cannot discriminate the stage of chronic liver disease in patients with severe chronic liver disease. Wolters Kluwer Health 2017-06-08 /pmc/articles/PMC5466232/ /pubmed/28591054 http://dx.doi.org/10.1097/MD.0000000000007101 Text en Copyright © 2017 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by/4.0 This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0
spellingShingle 3300
Dumitrescu, Gabriel
Januszkiewicz, Anna
Ågren, Anna
Magnusson, Maria
Wahlin, Staffan
Wernerman, Jan
Thromboelastometry: Relation to the severity of liver cirrhosis in patients considered for liver transplantation
title Thromboelastometry: Relation to the severity of liver cirrhosis in patients considered for liver transplantation
title_full Thromboelastometry: Relation to the severity of liver cirrhosis in patients considered for liver transplantation
title_fullStr Thromboelastometry: Relation to the severity of liver cirrhosis in patients considered for liver transplantation
title_full_unstemmed Thromboelastometry: Relation to the severity of liver cirrhosis in patients considered for liver transplantation
title_short Thromboelastometry: Relation to the severity of liver cirrhosis in patients considered for liver transplantation
title_sort thromboelastometry: relation to the severity of liver cirrhosis in patients considered for liver transplantation
topic 3300
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5466232/
https://www.ncbi.nlm.nih.gov/pubmed/28591054
http://dx.doi.org/10.1097/MD.0000000000007101
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