Lysis Timer: a new sensitive tool to diagnose hyperfibrinolysis in liver transplantation
Lysis Timer: a new sensitive tool to diagnose hyperfibrinolysis in liver transplantation
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DOI：
10.1136/jclinpath-2018-205280
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发表时间：
2019-01-01
影响因子：
3.4
通讯作者：
Freyburger, Genevieve
中科院分区：
文献类型：
--
作者：
Roullet, Stephanie;Labrouche, Sylvie;Freyburger, Genevieve
目的原位肝移植术后纤溶亢进的诊断仍具有挑战性。优球蛋白凝块溶解时间（ECLT）不适用于临床情况。ROTEM对纤溶亢进有特异性，但敏感性不高。裂解计时器评估枸橼酸血浆中的“总纤溶能力”（GFC/LT）。GFC/LT结合了体外触发凝块（凝血酶和钙）及其溶解（组织纤溶酶原激活剂（t-PA））的试剂，通过溶解计时器采集浊度信号，以及将数字信号转换为光学曲线的专用软件。对曲线进行系统的目视检查，以确定由软件计算的裂解时间值。这项前瞻性观察性研究的主要目的是评估GFC/LT在奥尔特期间识别纤溶亢进的能力。第二个目的是比较其结果与ROTEM最大溶解（EXTEM ML），并与标准的实验室tests.Methods 30例连续接受奥尔特的成人患者（NCT 03012633）。结果GFC/LT与ECLT、纤溶酶激活物抑制物1（PAI 1）抗原和活性、t-PA活性相关（r分别为0.490、0.681、0.643和-0.359）。纤溶亢进定义为ECLT 60 min，受试者工作特征曲线分析表明，阈值为31 min的GFC/LT检测纤溶亢进的灵敏度为0.88（95% CI 0.73 - 0.96），特异性0.68（95% CI 0.56 - 0.78），曲线下面积（AUC）0.85（95% CI 0.74 - 0.94）。EXTEM ML >12%未检测到纤溶亢进（灵敏度0.38（95% CI 0.24至0.55），特异性0.95（95% CI 0.86 - 0.99）和AUC 0.60（95% CI 0.46至0.75））。LT在奥尔特期间识别纤溶亢进，与其他纤溶试验显著一致。试验注册号NCT 03012633。
Aims Diagnosis of hyperfibrinolysis in orthotopic liver transplantation (OLT) remains challenging. Euglobulin clot lysis time (ECLT) is not adapted to clinical situations. ROTEM is specific but seldom sensitive to hyperfibrinolysis. The Lysis Timer assesses Global Fibrinolytic Capacity' in citrated plasma (GFC/LT). GFC/LT associates reagents for in vitro triggering of the clot (thrombin and calcium) and its lysis (tissue-plasminogenactivator (t-PA)), turbidity signal acquisition by the Lysis Timer, and dedicated software converting the digital signal into an optical curve. A visual check of the curves was systematic to ascertain the lysis time values calculated by the software. The primary aim of this prospective observational study was to evaluate the ability of GFC/LT to recognise hyperfibrinolysis during OLT. The secondary aim was to compare its results with ROTEM maximum lysis (EXTEM ML) and with standard laboratory tests.Methods Thirty consecutive adult patients undergoing OLT were included (NCT03012633). Standard laboratory tests, ROTEM, GFC/LT, ECLT and fibrinolysis parameters were assayed at five sample times.Results GFC/LT was correlated with ECLT, plasmin activator inhibitor 1 antigen and activity and t-PA activity (r=0.490, 0.681, 0.643 and -0.359, respectively). Hyperfibrinolysis was defined as ECLT 60 min. Receiver operating characteristic curve analysis showed that GFC/LT with a threshold of 31 min detected hyperfibrinolysis with a sensitivity of 0.88 (95% CI 0.73 to 0.96), a specificity of 0.68 (95% CI 0.56 to 0.78) and an area under the curve (AUC) of 0.85 (95% CI 0.74 to 0.94). EXTEM ML >12% did not detect hyperfibrinolysis (sensitivity 0.38 (95% CI 0.24 to 0.55), specificity 0.95 (95% CI 0.86 to 0.99) and AUC 0.60 (95% CI 0.46 to 0.75)).Conclusions GFC/LT recognised hyperfibrinolysis during OLT with a significant agreement with the other tests of fibrinolysis.Trial registration numberNCT03012633.