title: Rotational thromboelastometry can detect factor XIII deficiency and bleeding diathesis in patients with cirrhosis.
abstract: Patients with progressive liver disease exhibit complex coagulation disorders. Factor XIII plays a crucial role in the last steps of haemostasis, and its deficiency is associated with an increased incidence of bleeding diathesis. However, current conventional coagulation tests cannot detect factor XIII deficiency. In this study, we examined factor XIII activity and the ability of rotational thromboelastometry to detect factor XIII deficiency and bleeding diathesis in patients with cirrhosis.
  
  
  
  We retrospectively studied 74 patients with cirrhosis, comparing the results of conventional coagulation tests (international normalized ratio, activated partial thromboplastin time, platelet count, fibrinogen level), rotational thromboelastometry, factor XIII activity and clinical scores.
  
  
  
  Patients with cirrhosis exhibited reduced factor XIII activity. Factor XIII activity was positively correlated with conventional coagulation parameters and rotational thromboelastometry values, such as maximum clot formation (MCF)extem(r=.48, P<.0001) and MCFfibtem(r=.60, P<.0001). However, maximum lysis (ML)extemand MLaptemwere not correlated with factor XIII activity. Three-month mortality rates (P=.0469) and bleeding complications (P<.0001) were significantly associated with lower factor XIII activity. Patients with haemorrhage exhibited significantly altered rotational thromboelastometry values.
  
  
  
  Reduced levels of MCFextemand MCFfibtembut not high levels of MLextemand MLaptemare associated with factor XIII deficiency in patients with liver disease. Therefore, substituting factor XIII should be considered for such patients to strengthen clot formation in patients experiencing haemorrhage or those who have undergone interventions.
authors.affiliation: Department of Gastroenterology and Hepatology, University Hospital, University Duisburg-Essen, Essen, Germany.
authors.forename: Sotiria
authors.initials: S
authors.lastname: Bedreli
authors.affiliation: Department of Gastroenterology and Hepatology, University Hospital, University Duisburg-Essen, Essen, Germany.
authors.forename: Jan-Peter
authors.initials: JP
authors.lastname: Sowa
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University Hospital, University Duisburg-Essen, Essen, Germany.
authors.forename: Saraa
authors.initials: S
authors.lastname: Malek
authors.affiliation: Department of Gastroenterology and Hepatology, University Hospital, University Duisburg-Essen, Essen, Germany.
authors.forename: Sandra
authors.initials: S
authors.lastname: Blomeyer
authors.affiliation: Department of Gastroenterology and Hepatology, University Hospital, University Duisburg-Essen, Essen, Germany.
authors.forename: Antonios
authors.initials: A
authors.lastname: Katsounas
authors.affiliation: Department of Gastroenterology and Hepatology, University Hospital, University Duisburg-Essen, Essen, Germany.
authors.forename: Guido
authors.initials: G
authors.lastname: Gerken
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University Hospital, University Duisburg-Essen, Essen, Germany.
authors.forename: Fuat H
authors.initials: FH
authors.lastname: Saner
authors.affiliation: Department of Gastroenterology and Hepatology, University Hospital, University Duisburg-Essen, Essen, Germany.
authors.forename: Ali
authors.initials: A
authors.lastname: Canbay
mesh_terms: D004198:Disease Susceptibility; D005177:Factor XIII Deficiency / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D005858:Germany; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D019934:International Normalized Ratio; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013916:Thrombelastography / Q000379:methods*
keywords: 
  ROTEM
  ; cirrhosis; coagulation; factor XIII; rotational thromboelastometry