title: Comparison of standard fibrinogen measurement methods with fibrin clot firmness assessed by thromboelastometry in patients with cirrhosis.
abstract: BACKGROUND
  The Clauss fibrinogen method and thrombin clotting time (TCT) are still routinely used in patients with cirrhosis to define fibrinogen concentration and clotting potential. The thromboelastometric functional fibrinogen FIBTEM assay evaluates the strength of fibrin-based clots in whole blood, providing information on both quantitative deficit and fibrin polymerization disorders.
  
  
  OBJECTIVE
  To compare these three methods of assessing fibrinogen in patients with cirrhosis of different aetiologies, characterized by impairment in fibrinogen concentration as well as functional aberrance.
  
  
  METHODS
  Sixty patients with alcoholic and 24 patients with cholestatic cirrhosis were included (Child-Pugh score (CPs)A, n=24; B, n=32; C, n=28). All parameters were compared with those from a control group. Maximum clot firmness (MCF) in the FIBTEM test was assessed in regard to its relevance in detection of qualitative fibrinogen disorders in comparison with results obtained by standard measurement methods, i.e. the Clauss fibrinogen method and TCT.
  
  
  RESULTS
  With increased cirrhosis severity, fibrinogen and FIBTEM-MCF levels significantly declined (p=0.002), while TCT was significantly prolonged (p=0.002). In all CPs groups, fibrinogen strongly correlated with FIBTEM-MCF (r=0.77, r=0.72, r=0.74; p<0.001), while cross-correlations of other assays were highly variable. The prevalence of decreased FIBTEM-MCF values (<9 mm) was significantly higher in advanced CPs categories (p=0.027), whereby the highest prevalence was detected in patients with CPsC (10/16; 62.5%). Nine of the 16 patients with decreased FIBTEM-MCF values had also decreased fibrinogen levels, while in the remaining 7 patients fibrinogen levels were within the reference range, indicating the possible presence of qualitatively altered fibrinogen that could be detected by FIBTEM-MCF.
  
  
  CONCLUSIONS
  FIBTEM-MCF may be considered as a reliable alternative to standard plasma fibrinogen measurement in cirrhotic patients, especially in evaluating fibrin polymerization disorders in these patients. Further studies are needed to evaluate the usefulness of this assay in predicting bleeding complications in cirrhotic patients as well as monitoring replacement treatment.
authors.affiliation: Clinic of Digestive Surgery, Clinical Center of Serbia, Belgrade, Serbia.
authors.forename: Dragica
authors.initials: D
authors.lastname: Vucelic
authors.affiliation: Faculty of Medicine, University of Belgrade, Serbia; Clinic of Gastroenterology and Hepatology, Clinical Center of Serbia, Belgrade, Serbia.
authors.forename: Rada
authors.initials: R
authors.lastname: Jesic
authors.affiliation: Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia; Center for Medical Biochemistry, Clinical Center of Serbia, Belgrade, Serbia.
authors.forename: Snezana
authors.initials: S
authors.lastname: Jovicic
authors.affiliation: Faculty of Medicine, University of Belgrade, Serbia; Institute of Pathology, Belgrade, Serbia.
authors.forename: Maja
authors.initials: M
authors.lastname: Zivotic
authors.affiliation: Clinic of Digestive Surgery, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Serbia.
authors.forename: Nikica
authors.initials: N
authors.lastname: Grubor
authors.affiliation: Faculty of Medicine, University of Belgrade, Serbia; Institute of Medical Statistics and Informatics, Belgrade, Serbia.
authors.forename: Goran
authors.initials: G
authors.lastname: Trajkovic
authors.affiliation: Center for Medical Biochemistry, Clinical Center of Serbia, Belgrade, Serbia.
authors.forename: Ivana
authors.initials: I
authors.lastname: Canic
authors.affiliation: Faculty of Medicine, University of Belgrade, Serbia; Clinic of Hematology, Clinical Center of Serbia, Belgrade, Serbia.
authors.forename: Ivo
authors.initials: I
authors.lastname: Elezovic
authors.affiliation: Karolinska Institute, Department of Medicine Solna, Rheumatology Unit and Karolinska University Hospital, Rheumatology Clinic, Stockholm, Sweden. Electronic address: aleksandra.antovic@ki.se.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Antovic
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000437:Alcoholism / Q000150:complications; D001777:Blood Coagulation; D001780:Blood Coagulation Tests / Q000379:methods*; D003430:Cross-Sectional Studies; D005260:Female; D005337:Fibrin / Q000737:chemistry*; D005340:Fibrinogen / Q000008:administration & dosage* / Q000096:biosynthesis / Q000737:chemistry / Q000235:genetics; D005355:Fibrosis / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D013916:Thrombelastography / Q000379:methods*; D013917:Thrombin / Q000737:chemistry; D013918:Thrombin Time; D055815:Young Adult
chemical_list: D005337:Fibrin; D005340:Fibrinogen; D013917:Thrombin
keywords: Cirrhosis; Fibrinogen; Standard measurement methods; Thromboelastometry