Significance of Sonoclot analysis for severity monitoring and evaluating perioperative liver transplantation recipients
10.3760/cma.j.cn421203-20230407-00070
- VernacularTitle:凝血与血小板功能分析对围手术期肝移植受者病情监测与评估的意义
- Author:
Yang LI
1
;
Yulin HE
;
Chunchen YANG
;
Ruiming RONG
;
Yi ZHANG
Author Information
1. 复旦大学附属中山医院输血科，上海 200032
- Keywords:
Liver transplantation;
Coagulation function test;
Transfusion indication
- From:
Chinese Journal of Organ Transplantation
2023;44(7):413-420
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the significance of coagulation and platelet function analysis (Sonoclot) in monitoring coagulation function, severity evaluation and blood transfusion indication of perioperative liver transplant (LT) recipients.Methods:A total of 95 perioperative LT recipients received Sonoclot, thromboelastography (TEG), routine coagulation panel, liver function panel, blood routine, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) scoring and model for end-stage liver disease (MELD) scoring between January 2021 and October 2022.The correlation analysis of the above parameters was performed.According to the scores of APACHE Ⅱ and MELD, they were assigned into three groups of low-risk, medium-risk and high-risk.The levels of Sonoclot parameters in each group were compared.They were divided into two groups of transfusion (n=31) and non-transfusion (n=64) according to the necessity or non-necessity of transfusion..The risk factors for blood transfusion were examined by Logistic regression and receiver operating characteristic (ROC) curve.Results:Pearson's correlation analysis indicated that activated clotting time (ACT) value was correlated positively with the levels of prothrombin time (PT), prothrombin time ratio (PTR), international standard ratio (INR), R/K value, alanine aminotransferase (ALT), aspartate aminotransferase (AST) and lactic dehydrogenase (LDH)( r=0.279 1, P=0.006 2; r=0.280 2, P=0.006 5; r=0.3, P=0.003 5; r=0.642 8, P<0.000 1; r=0.452 8, P<0.000 1; r=0.377 6, P=0.002; r=0.349 6, P=0.000 6; r=0.271 4, P=0.018 3) and yet negatively with the levels of platelet (PLT), MA, CI and α ( r=-0.339 1, P=0.000 8; r=-0.573 3, P<0.000 1; r=-0.656 3, P<0.000 1; r=-0.632 6, P<0.000 1); CR value was correlated positively with the levels of maximal amplitude (MA), coagulation index (CI), α and ALT ( r=0.466 8, P=0.000 6; r=0.482 7, P=0.000 4; r=0.514 8, P=0.000 1; r=0.229 2, P=0.027 1) and yet negatively with the level of R/K value ( r=-0.366 9, P=0.010 3; r=-0.356 9, P=0.011 0); platelet function (PF) value was correlated positively with the levels of PLT, MA, CI, α and alkaline phosphatase (ALP)( r=0.481 9, P<0.000 1; r=0.630 7, P<0.000 1; r=0.623 5, P<0.000 1; r=0.593 0, P<0.000 1; r=0.223 1, P=0.032 5) and yet negatively with the level of R/K value ( r=-0.421 5, P=0.002 8; r=-0.530 7, P<0.000 1). CR value was correlated negatively with APACHE Ⅱ score ( r=-0.212 3, P=0.038 9) while ACT value was correlated positively with MELD score ( r=0.244, P=0.04). ACT values spiked in low, middle and high-risk groups of APACHE Ⅱ and MELD scores while PF value declined gradually by grouping these recipients based upon scoring systems.CR values decreased merely in MELD score.Logistic regression analysis indicated that ACT was a risk factor for necessity of blood transfusion in perioperative LT recipients ( OR=1.010, 95% CI 1.000-1.019, P<0.05). The maximal area under the curve of ROC curve analysis plus ACT, hemoglobin (Hb) and hematocrit (Hct) was 0.896. Conclusions:Sonoclot parameters of perioperative LT recipients have some certain correlation with thromboelastographic and conventional coagulation parameters.Both may serve as a supplementary means.Associated with liver function parameters and liver scores, Sonoclot parameters are significant for early clinical evaluations.Sonoclot parameters plus Hb/Hct detection have some guiding significance for perioperative LT recipients with necessity for blood transfusion and blood products.
