Thrombelastographic pattern recognition in renal disease and trauma.
Thrombelastographic pattern recognition in renal disease and trauma.
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肾脏疾病和创伤中的血栓弹力图模式识别。
DOI：
10.1016/j.jss.2014.12.012
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发表时间：
2015
期刊：
影响因子：
--
通讯作者：
Banerjee,Anirban
中科院分区：
文献类型：
--
作者：
Chapman,MichaelP;Moore,ErnestE;Burneikis,Dominykas;Moore,HunterB;Gonzalez,Eduardo;Anderson,KelseyC;Ramos,ChristopherR;Banerjee,Anirban
血栓弹力图（TEG）是一种粘弹性止血方法。我们观察到终末期肾病（ESRD）和创伤性凝血病（TIC）产生不同的TEG描记。我们假设，严格定义的TEG模式可以区分健康对照和患者与终末期肾病和TIC.MethodsTEG进行血液从终末期肾病患者（n= 54）和创伤患者的血液需要大量输血（n= 16）。图独立TEG参数进行了分析模式耦合到疾病状态，与对照组相比。分类学分类的决策树，然后建立使用“R-项目”统计软件。ResultsMinimally重叠集群的TEG结果观察三个患者组时，坐标对的最大振幅（MA）和TEG激活凝血时间（ACT）绘制在正交轴上。基于这些分组，使用MA和TEG ACT构建了分类树。分支点设置为ACT 103 s，高ACT分支为60.8 mm，低ACT分支为72.6 mm，分类正确率为93.4%。终末期肾病的凝血功能障碍的典型表现是血凝块形成的酶相延长，最终血凝块强度正常至升高。相反，TIA的典型特征是血栓形成时间延长和血栓强度减弱。我们的分类分类构成了一个严格的系统，基于聚类分析的算法解释TEG。这将形成粘弹性止血测定的临床决策支持软件的基础。
BackgroundThrombelastography (TEG) is a viscoelastic hemostatic assay. We have observed that end-stage renal disease (ESRD) and trauma-induced coagulopathy (TIC) produce distinctive TEG tracings. We hypothesized that rigorously definable TEG patterns could discriminate between healthy controls and patients with ESRD and TIC.MethodsTEG was performed on blood from ESRD patients (n= 54) and blood from trauma patients requiring a massive blood transfusion (n= 16). Plots of independent TEG parameters were analyzed for patterns coupled to disease state, compared with controls. Decision trees for taxonomic classification were then built using the “R-Project” statistical software.ResultsMinimally overlapping clusters of TEG results were observed for the three patient groups when coordinate pairs of maximum amplitude (MA) and TEG-activated clotting time (ACT) were plotted on orthogonal axes. Based on these groupings, a taxonomical classification tree was constructed using MA and TEG ACT. Branch points were set at an ACT of 103 s, and these branches subdivided for MA at 60.8 mm for the high ACT branch and 72.6 mm for the low ACT branch, providing a correct classification rate of 93.4%.ConclusionsESRD and TIC demonstrate distinct TEG patterns. The coagulopathy of ESRD is typified by a prolonged enzymatic phase of clot formation, with normal-to-elevated final clot strength. Conversely, TIC is typified by prolonged clot formation and weakened clot strength. Our taxonomic categorization constitutes a rigorous system for the algorithmic interpretation of TEG based on cluster analysis. This will form the basis for clinical decision support software for viscoelastic hemostatic assays.
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