title: Thromboelastographic Evaluation of Coagulation in Patients With Liver Disease.
abstract: BACKGROUND
  The aims of this study were to investigate the parameters of thromboelastography (TEG) for evaluating coagulopathy and to reveal an association with disease severity and/or transfusion requirement in patients with chronic liver disease (CLD) in a clinical laboratory setting.
  
  
  METHODS
  We enrolled two groups of adult patients with cirrhotic (N=123) and non-cirrhotic liver disease (N=52), as well as 84 healthy controls. Reaction time (R), kinetic time (K), α-angle (α), maximal amplitude (MA), and coagulation index (CI) were measured with kaolin-activated citrated blood with the TEG 5000 system (Haemonetics Corporation, USA). Platelet count, prothrombin time international normalized ratio (PT INR), albumin, bilirubin, and creatinine were simultaneously measured. The CLD severity was calculated by using the Child-Pugh (C-P) and Model for End-stage Liver Disease (MELD) scores. Transfusion history was also reviewed.
  
  
  RESULTS
  All TEG parameters, PT INR, and platelet count in the cirrhotic group showed significant differences from those in other groups. At least one or more abnormal TEG parameters were identified in 17.3% and 44.7% of patients in the non-cirrhotic and cirrhotic group, respectively. Patients with cirrhotic disease had hypocoagulability. A weak correlation between R and PT INR (r=0.173) was noted. The TEG parameters could not predict CLD severity using the C-P and MELD scores. Patients with normal TEG parameters did not receive transfusion.
  
  
  CONCLUSIONS
  Clinical application of TEG measurements in CLD can be informative for investigating coagulopathy or predicting the risk of bleeding. Further studies are warranted.
authors.affiliation: Department of Laboratory Medicine, Pusan National University School of Medicine and Biomedical Research Institute Research Institute, Pusan National University Hospital, Busan, Korea.
authors.forename: Kyung Hwa
authors.initials: KH
authors.lastname: Shin
authors.affiliation: Department of Laboratory Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea. iskim0710@gmail.com.
authors.forename: In Suk
authors.initials: IS
authors.lastname: Kim
authors.affiliation: Department of Laboratory Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
authors.forename: Hyun Ji
authors.initials: HJ
authors.lastname: Lee
authors.affiliation: Department of Laboratory Medicine, Pusan National University School of Medicine and Biomedical Research Institute Research Institute, Pusan National University Hospital, Busan, Korea.
authors.forename: Hyung Hoi
authors.initials: HH
authors.lastname: Kim
authors.affiliation: Department of Laboratory Medicine, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
authors.forename: Chulhun L
authors.initials: CL
authors.lastname: Chang
authors.affiliation: Department of Internal Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
authors.forename: Young Mi
authors.initials: YM
authors.lastname: Hong
authors.affiliation: Department of Internal Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
authors.forename: Ki Tae
authors.initials: KT
authors.lastname: Yoon
authors.affiliation: Department of Internal Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
authors.forename: Mong
authors.initials: M
authors.lastname: Cho
mesh_terms: D000328:Adult; D000368:Aged; D001663:Bilirubin / Q000097:blood; D001777:Blood Coagulation / Q000502:physiology*; D001803:Blood Transfusion; D016022:Case-Control Studies; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000473:pathology; D008107:Liver Diseases / Q000097:blood / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011517:Prothrombin Time; D012720:Severity of Illness Index; D013916:Thrombelastography
chemical_list: D003404:Creatinine; D001663:Bilirubin
keywords: Coagulation; Liver disease; Thromboelastography; Transfusion