TEG evaluation and blood transfusion prediction model for patients with upper gastrointestinal bleeding
10.13303/j.cjbt.issn.1004-549x.2021.11.008
- VernacularTitle:上消化道出血患者TEG评估及输血预测模型分析
- Author:
Yaoqiang DU
1
;
Yilin XU
2
;
Yexiaoqing YANG
3
;
Luxi JIANG
1
;
Huilin YANG
4
;
Jian WANG
4
;
Ke HAO
1
;
Zhen WANG
1
;
Jianxin LYU
5
;
Bingyu CHEN
1
Author Information
1. Department of Blood Transfusion, Zhejiang Provincial People′s Hospital, Hangzhou 310014, China
2. School of Life Sciences, School of Laboratory Medicine, Wenzhou Medical University
3. Ningbo First Hospital
4. Zhejiang Provincial People′s Hospital(Chun′an Branch), the First People′s Hospital of Chun′an County
5. School of Laboratory Medicine, Hangzhou Medical College
- Publication Type:Journal Article
- Keywords:
upper gastrointestinal bleeding;
thrombelastogram(TEG);
coagulation function;
transfusion prediction;
logistic regression
- From:
Chinese Journal of Blood Transfusion
2021;34(11):1202-1206
- CountryChina
- Language:Chinese
-
Abstract:
【Objective】 To establish a blood transfusion outcome prediction model for comprehensivel evaluation of coagulation function of patients with upper gastrointestinal bleeding by thrombelastogram (TEG) and blood coagulation indicators. 【Methods】 The data of 101 patients with upper gastrointestinal hemorrhage, admitted to the Department of Gastroenterology of Zhejiang Provincial People′s Hospital and its Chun′an Branch from June 2018 to June 2021, were collected through Tongshuo blood transfusion management system and His system. Those patients were divided into blood transfusion group (n=56) and non-transfusion group (n=45), and into cirrhosis group (n=74) and non-cirrhosis group (n=27), and 40 patients, with non-upper gastrointestinal bleeding, were enrolled as the control. The results of TEG indicators (R, K, α, MA), coagulation function (PT, INR, APTT, TT, Fib), blood routine (Hb, Plt, WBC, NEUT%) and biochemical detection(Alb, SCr, ALT, AST, GGT) before transfusion were compared between groups and the correlation between TEG indicators and traditional coagulation parameters was analyzed. Single-factor and multi-factor analysis were used to screen blood transfusion-related factors to establish a predictive model. 【Results】 The comparisons of paremeters between transfusion and non-transfusion group were as follows, K (min), α (°), and MA (mm) was 3.86±3.12 vs 2.50±1.47, 54.00±14.08 vs 61.05±10.88, and 51.12±13.37 vs 58.26±11.08, respectively (P<0.01); PT (s) and Fib (g) was 16.36±7.45 vs 13.44±1.50 and 1.59±0.87 vs 2.35±1.09 (P<0.01); NEUT% and Hb (g/L) was 0.75 ±0.13 vs 0.66±0.15 and 68.04±14.49 vs 100.73±22.92 (P<0.01); Alb (g/L) and SCr (nmol/L) was 29.73±6.08 vs 33.73±7.19 and 99.50±53.55 vs 76.25±19.28 (P<0.01). Correlation analysis showed that APTT was positively correlated with R and K values, and negatively correlated with α and MA. Fib was negatively correlated with K values, and positively correlated with α and MA. Plt was negatively correlated with K values, and positively correlated with α and MA (P<0.01). Eight pre-transfusion indicators as K, MA, PT, Fib, NEUT%, Hb, Alb, and SCr were subjected to Logistic regression to establish a blood transfusion prediction model. The optimal ROC curve of blood transfusion threshold (blood transfusion predictive value of patients), sensitivity, specificity and AUC were 0.448, 92.9%, 88.9%, and 0.969, respectively. 【Conclusion】 The establishment of Logistic regression model by integrating detection indicators of TEG, coagulation function, blood routine and biochemistry in patients with upper gastrointestinal bleeding have showed significant correlation with blood transfusion prediction, and good clinical practicability.
