Abstract：
UNASSIGNED: Patients with cirrhosis of the liver are in a delicate state of rebalanced haemostasis and are at risk of developing both bleeding and thrombotic complications. Conventional haemostatic tests are unable to predict bleeding and thrombosis in these patients. We aimed to explore the role of Rotational Thromboelastometry (ROTEM) in predicting bleeding and thrombotic events in patients with cirrhosis.
UNASSIGNED: We conducted a prospective cohort study of patients with cirrhosis at two metropolitan hospitals. All patients underwent ROTEM analysis and were then followed to record any bleeding and thrombotic events. Univariate and multivariate logistic regression analyses were performed to explore associations with bleeding and thrombotic events.
UNASSIGNED: Nineteen of the 162 patients recruited experienced a bleeding event within one year of ROTEM analysis. On univariate analysis, maximum clot firmness (MCF) using both EXTEM and INTEM tests was significantly reduced in patients who had a bleeding event, compared to those who did not (50 mm vs. 57 mm, p < 0.01 and 48 mm vs. 54 mm, p < 0.01, respectively). In addition, on univariate analysis, clotting time (CT) in the INTEM test was prolonged in the bleeding group (214 s vs. 198 s, p = 0.01). On multivariate analysis, only MCFEX was a significant predictor of bleeding events. In contrast, there was no association found between ROTEM parameters and development of thrombosis within a one-year period.
UNASSIGNED: ROTEM may provide a useful tool in predicting future bleeding events in patients with cirrhosis. Larger studies are required to further validate this finding and explore its application in clinical practice.
UNASSIGNED: We conducted a prospective cohort study of patients with cirrhosis at two metropolitan hospitals. All patients underwent ROTEM analysis and were then followed to record any bleeding and thrombotic events. Univariate and multivariate logistic regression analyses were performed to explore associations with bleeding and thrombotic events.
UNASSIGNED: Nineteen of the 162 patients recruited experienced a bleeding event within one year of ROTEM analysis. On univariate analysis, maximum clot firmness (MCF) using both EXTEM and INTEM tests was significantly reduced in patients who had a bleeding event, compared to those who did not (50 mm vs. 57 mm, p < 0.01 and 48 mm vs. 54 mm, p < 0.01, respectively). In addition, on univariate analysis, clotting time (CT) in the INTEM test was prolonged in the bleeding group (214 s vs. 198 s, p = 0.01). On multivariate analysis, only MCFEX was a significant predictor of bleeding events. In contrast, there was no association found between ROTEM parameters and development of thrombosis within a one-year period.
UNASSIGNED: ROTEM may provide a useful tool in predicting future bleeding events in patients with cirrhosis. Larger studies are required to further validate this finding and explore its application in clinical practice.
摘要：
肝硬化患者处于平衡止血的微妙状态，并且有发生出血和血栓并发症的风险。常规止血试验无法预测这些患者的出血和血栓形成。我们旨在探讨旋转血栓弹性测量（ROTEM）在预测肝硬化患者出血和血栓事件中的作用。
■我们对两家大都市医院的肝硬化患者进行了一项前瞻性队列研究。所有患者均接受ROTEM分析，然后随访以记录任何出血和血栓事件。进行单变量和多变量逻辑回归分析以探讨与出血和血栓形成事件的关系。
■招募的162名患者中有19名在ROTEM分析的一年内经历了出血事件。在单变量分析中，在发生出血事件的患者中，使用EXTEM和INTEM测试的最大凝块硬度（MCF）显着降低，与那些没有(50毫米vs.57毫米，p<0.01和48mmvs.54毫米，p分别<0.01)。此外,在单变量分析中，出血组INTEM试验中的凝血时间（CT）延长（214svs.198s,p=0.01)。在多变量分析中，只有MCFEX是出血事件的重要预测因子.相比之下,未发现ROTEM参数与1年内血栓形成之间的关联.
■ROTEM可能为预测肝硬化患者未来的出血事件提供有用的工具。需要更大规模的研究来进一步验证这一发现并探索其在临床实践中的应用。
■我们对两家大都市医院的肝硬化患者进行了一项前瞻性队列研究。所有患者均接受ROTEM分析，然后随访以记录任何出血和血栓事件。进行单变量和多变量逻辑回归分析以探讨与出血和血栓形成事件的关系。
■招募的162名患者中有19名在ROTEM分析的一年内经历了出血事件。在单变量分析中，在发生出血事件的患者中，使用EXTEM和INTEM测试的最大凝块硬度（MCF）显着降低，与那些没有(50毫米vs.57毫米，p<0.01和48mmvs.54毫米，p分别<0.01)。此外,在单变量分析中，出血组INTEM试验中的凝血时间（CT）延长（214svs.198s,p=0.01)。在多变量分析中，只有MCFEX是出血事件的重要预测因子.相比之下,未发现ROTEM参数与1年内血栓形成之间的关联.
■ROTEM可能为预测肝硬化患者未来的出血事件提供有用的工具。需要更大规模的研究来进一步验证这一发现并探索其在临床实践中的应用。
