Dataset Information

Thromboelastometry in patients with advanced chronic liver disease stratified by severity of portal hypertension.

ABSTRACT:

Background

Rotational thromboelastometry (ROTEM) has been studied in patients with advanced chronic liver disease (ACLD) without considering the impact of portal hypertension. We evaluated the influence of the hepatic venous pressure gradient (HVPG) on ROTEM results in patients with ACLD.

Methods

Cross-sectional study; ACLD patients undergoing HVPG measurement within the prospective Vienna Cirrhosis Study (NCT03267615) underwent concomitant ROTEM testing.

Results

Among 159 patients (68% male; Child-Pugh-A: 53%, Child-Pugh-B: 34%, Child-Pugh-C: 13%), 21 patients (13%) had a HVPG between 6 and 10 mmHg, 84 patients (53%) between 10 and 19 mmHg, and 54 patients (34%)???20 mmHg. Child-Pugh-C patients (vs. Child-Pugh-A and vs. Child-Pugh-B patients, respectively) showed longer clot formation time (CFT: median 187 s vs. 122 s vs. 122 s, p?=?0.007) and lower maximum clot firmness (MCF: median: 45 mm vs. 56 mm vs. 56 mm, p?=?0.002) in extrinsic thromboelastometry (EXTEM), while platelet counts were similar across Child-Pugh stages. In the overall cohort, ROTEM parameters did not differ by severity of portal hypertension. However, among compensated Child-Pugh-A patients, MCF decreased with increasing portal pressure, i.e. in higher HVPG strata (HVPG 9-10 mmHg: median MCF: 59 mm vs. HVPG 10-19 mmHg: 56 mm vs HVPG???20 mmHg: 54 mm, p?=?0.023). Furthermore, patients with short CFT and high MCF in EXTEM had higher levels of lipopolysaccharide-binding protein, C-reactive protein, and procalcitonin, as well as higher leukocyte counts (all p?ConclusionsPortal hypertension seems to impact ROTEM results only in compensated Child-Pugh-A patients. Bacterial translocation and systemic inflammation may trigger a procoagulant state in patients with ACLD.

SUBMITTER: Raeven P

PROVIDER: S-EPMC7803675 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

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Publications

Thromboelastometry in patients with advanced chronic liver disease stratified by severity of portal hypertension.

Raeven Pierre P Baron-Stefaniak Joanna J Simbrunner Benedikt B Stadlmann Alexander A Schwabl Philipp P Scheiner Bernhard B Schaden Eva E Eigenbauer Ernst E Quehenberger Peter P Mandorfer Mattias M Baron David Marek DM Reiberger Thomas T

Hepatology international 20200930 6

<h4>Background</h4>Rotational thromboelastometry (ROTEM) has been studied in patients with advanced chronic liver disease (ACLD) without considering the impact of portal hypertension. We evaluated the influence of the hepatic venous pressure gradient (HVPG) on ROTEM results in patients with ACLD.<h4>Methods</h4>Cross-sectional study; ACLD patients undergoing HVPG measurement within the prospective Vienna Cirrhosis Study (NCT03267615) underwent concomitant ROTEM testing.<h4>Results</h4>Among 159 ...[more]

PMID: 33000389

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Project description:Background and aimsThe liver plays a key role in the storage, metabolism and homeostasis of fat-soluble vitamins. We investigated the relation of Vitamin(Vit)A/D/E serum levels with severity of liver disease and portal hypertension (PHT).MethodsVitA/D/E serum levels were assessed in 234 patients with advanced chronic liver disease (ACLD, i.e. hepatic venous pressure gradient [HVPG]???6 mmHg). Patients with hepatocellular carcinoma, pre-/post-hepatic PHT, TIPS or liver transplantation were excluded.ResultsMost patients were male (n?=?153; 65%) with a median age of 57.6 (49.7-64.5) years. Thirty-two (14%) patients had HVPG 6-9 mmHg, 66 (28%) 10-15 mmHg, and 136 (58%)???16 mmHg, respectively. VitD deficiency (25-OH-vitamin-D?<50 nmol/L) was found in 133 (57%) with higher prevalence in Child-Turcotte-Pugh (CTP)-C: 85% vs. B: 66% vs. A: 47% (p?<?0.001). VitD levels displayed significant but weak correlations with hepatic dysfunction and PHT. VitE levels were normal in 227 (97%) patients and displayed no relevant association with hepatic dysfunction or PHT. Only 63 (27%) patients had normal (>1.05 µmol/L) VitA levels, while 58 (25%) had mild (0.70-1.04 µmol/L), 71 (30%) moderate (0.35-0.69 µmol/L), and 42(18%) severe(<0.35 µmol/L) VitA deficiency. VitA correlated with HVPG (Rho?=?-0.409), CTP score (Rho?=?-0.646), and serum bile acid levels (Rho?=?-0.531; all p?<?0.001). The prevalence of decompensated ACLD (dACLD) continuously increased with severity of VitA deficiency (no: 40% vs. mild: 51% vs. moderate: 67% vs. severe: 91% had dACLD; p?<?0.001). CTP score (per point; OR 2.46; 95%CI 1.80-3.37; p?<0.001), age (per year; OR 0.95; 95%CI 0.92-0.98; p?=?0.001) and elevated bile acid levels(>10 µmol/L; OR 3.62; 95%CI 1.61-8.14; p?=?0.002) were independently associated with VitA deficiency.ConclusionVitA and VitD but not VitE deficiencies are highly prevalent in ACLD. VitA deficiency strongly correlates with hepatic dysfunction, PHT and bile acid levels and is associated with decompensated ACLD.Trial registration numberNCT03267615.

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Dataset Information

Thromboelastometry in patients with advanced chronic liver disease stratified by severity of portal hypertension.

Background

Methods

Results

Publications

Thromboelastometry in patients with advanced chronic liver disease stratified by severity of portal hypertension.

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