Coagulation Parameters and Major Bleeding in Critically Ill Patients With Cirrhosis
Coagulation Parameters and Major Bleeding in Critically Ill Patients With Cirrhosis
复制标题
DOI：
10.1002/hep.28628
复制
发表时间：
2016-08-01
期刊：
影响因子：
13.5
通讯作者：
Fuhrmann, Valentin
中科院分区：
文献类型：
--
作者：
Drolz, Andreas;Horvatits, Thomas;Fuhrmann, Valentin
凝血和止血功能紊乱在肝硬变患者中很常见。典型的实验室模式模拟弥散性血管内凝血(DIC)。本研究的目的是评估危重肝硬变患者常规凝血参数对新发大出血和预后的影响。共有1,493名危重患者接受前瞻性研究。评估常规凝血参数，并根据血小板、纤维蛋白原、d-二聚体和凝血酶原指数计算DIC评分。评估了在重症监护病房逗留期间新发生的大出血和死亡率。随访1年。队列中的211名患者患有肝硬变。血小板、纤维蛋白原、凝血酶原指数、活化部分凝血活酶时间、D-二聚体以及弥漫性血管内凝血分数在有肝硬化组和无肝硬化组之间有显著差异(P<；0.001)。此外，纤维蛋白原、血小板和活化的部分凝血活酶时间(但不包括凝血酶原指数)在有大出血和无大出血的肝硬变患者之间有显著差异(均P<；0.01)。入院时出血，血小板计数
Disturbances of coagulation and hemostasis are common in patients with liver cirrhosis. The typical laboratory pattern mimics disseminated intravascular coagulation (DIC). The aim of this study was to assess the impact of routine coagulation parameters in critically ill cirrhosis patients with regard to new onset of major bleeding and outcome. A total of 1,493 critically ill patients were studied prospectively. Routine coagulation parameters were assessed, and the DIC score was calculated based on platelets, fibrinogen, d-dimer, and prothrombin index. New onset of major bleeding during the stay at the intensive care unit and mortality were assessed. Patients were followed for 1 year. Two hundred eleven patients of the cohort had liver cirrhosis. Platelets, fibrinogen, prothrombin index, activated partial thromboplastin time, and d-dimer as well as the DIC score differed significantly between patients with and without cirrhosis (P < 0.001 for all). Moreover, fibrinogen, platelets, and activated partial thromboplastin time (but not prothrombin index) differed significantly between cirrhosis patients with and without major bleeding (P < 0.01 for all). Bleeding on admission, platelet count