Preoperative thrombelastography maximum amplitude predicts massive transfusion in liver transplantation
Preoperative thrombelastography maximum amplitude predicts massive transfusion in liver transplantation
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DOI：
10.1016/j.jss.2017.05.115
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发表时间：
2017-12-01
影响因子：
2.2
通讯作者：
Nydam, Trevor L.
中科院分区：
文献类型：
--
作者：
Lawson, Peter J.;Moore, Hunter B.;Nydam, Trevor L.
背景：肝移植过程中经常需要大量输血。移植患者患MT的风险分层是一个很有吸引力的概念，但仍未得到充分的研究。血栓弹力成像(TEG)最近被证明用于创伤复苏时可以降低死亡率。我们假设，术前TEG可以用来对MT患者进行风险分层。材料和方法：肝移植患者在手术切开前抽血，并通过TEG进行检测。除标准的实验室凝血试验外，还收集了术前TEG的测量结果。TEG变量包括R时间(反应时间)、角度、最大幅度(MA)和LY30(MA后30分钟血栓溶解)，与术后24小时内的红细胞单位、血浆(新鲜冰冻血浆)、冷沉淀和血小板相关，并使用接收器操作特征曲线测试其性能。结果：28名患者进入分析，终末期肝病模型评分中位数为17分；36%接受了MT。与MT(定义为>；=10个红细胞单位/24小时)相关的TEG变量是低MA(P<；0.001)和低角度(P=0.014)。凝血酶原时间国际标准化比率高(P=0.003)和血小板计数低(P=0.007)也与MT有关。MA的曲线下面积最大(0.861)，其次是凝血酶原时间国际标准化比率(0.803)。MA<47 mm预测MT的敏感性为90%，特异性为72%。MA是唯一与所有输血产品密切相关的凝血指标。结论：TAG MA对肝移植术后MT有较高的预测性。由于只有三分之一的患者需要移植，术前使用TEG可能有助于指导该程序更具成本效益的血库准备。(C)2017 Elsevier Inc.保留所有权利。
Background: Massive transfusion (MT) is frequently required during liver transplantation. Risk stratification of transplant patients at risk for MT is an appealing concept but remains poorly developed. Thrombelastography (TEG) has recently been shown to reduce mortality when used for trauma resuscitation. We hypothesize that preoperative TEG can be used to risk stratify patients for MT.Material and methods: Liver transplant patients had blood drawn before surgical incision and assayed via TEG. Preoperative TEG measurements were collected in addition to standard laboratory coagulation tests. TEGvariables including R-time (reaction time), angle, maximum amplitude (MA), and LY30 (clot lysis 30 min after MA) were correlated to red blood cell units, plasma (fresh frozen plasma), cryoprecipitate, and platelets during the first 24 h after surgery and tested for their performance using a receiver-operating characteristic curve.Results: Twenty-eight patients were included in the analysis with a median Model for End-Stage Liver Disease score of 17; 36% received a MT. The TEG variables associated with MT (defined as >= 10 red blood cell units/24 h) were a low MA (P < 0.001) and low angle (P = 0.014). A high international normalized ratio of prothrombin time (P = 0.003) and low platelet count (P = 0.007) were also associated with MT. MA had the highest area under the curve (0.861) followed by international normalized ratio of prothrombin time (0.803). An MA of less than 47 mm has a sensitivity of 90% and specificity of 72% to predict a MT. MA was the only coagulation variable that correlated strongly to all blood products transfused.Conclusions: TEG MA has a high predictability of MT during liver transplantation. The use of TEG preoperatively may help guide more cost effective blood bank preparation for this procedure as only a third of patients required a MT. (C) 2017 Elsevier Inc. All rights reserved.