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Assessment of Plasma Coagulation on Liver Tissue in a Large Animal Model In Vivo
Published on: August 4, 2018
Hypocoagulability in Children With Decompensated Chronic Liver Disease and Sepsis: Assessment by Thromboelastography
Vignesh Vinayagamoorthy1, Anshu Srivastava1, Indranil Das2
1From the Department of Paediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Insights
Children with decompensated chronic liver disease and infection often have abnormal coagulation, with thromboelastography (TEG) identifying hypocoagulable states and predicting poor outcomes. TEG is superior to INR and platelet counts for detecting bleeding risks.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Hematology
Background:
- Decompensated chronic liver disease (DCLD) in children presents complex challenges, often complicated by infections.
- Coagulation abnormalities are common in DCLD, potentially exacerbated by systemic infections.
- Accurate assessment of coagulation status is crucial for managing these critically ill children.
Purpose of the Study:
- To evaluate the coagulation status in children with DCLD and concurrent infection using thromboelastography (TEG).
- To identify factors influencing coagulation abnormalities in this pediatric population.
- To assess the predictive value of TEG parameters for bleeding and patient outcomes.
Main Methods:
- Prospective study of 30 children with DCLD and infection.
- Coagulation assessed using international normalized ratio (INR), platelet count, and TEG (R, K, α-angle, MA, CI, LY30) at admission and post-treatment.
- Clinical data including systemic inflammatory response syndrome (SIRS), infection severity, bleeding events, and outcomes were collected.
Main Results:
- At admission, 96.7% had prolonged INR, 80% thrombocytopenia, and 56.6% were hypocoagulable by TEG.
- Hypocoagulability was more frequent in severe sepsis (81.1%) and persistent SIRS (100%).
- Bleeding patients showed prolonged R-time and reduced MA/α-angle compared to non-bleeders; R-time ≥8.5 min predicted mortality (83% sensitivity, 100% specificity).
Conclusions:
- Over half of children with DCLD and infection exhibit hypocoagulability detectable by TEG.
- Severe sepsis and persistent SIRS significantly worsen coagulation status.
- TEG provides superior insights into bleeding risk and predicts poor outcomes more effectively than traditional coagulation tests.
Objective:
To evaluate the coagulation status of children with decompensated chronic liver disease (DCLD) and infection and factors affecting it using thromboelastography (TEG).
Methods:
Coagulation status of children admitted with DCLD and infection was assessed by international normalized ratio (INR), platelet count, and TEG [reaction time (R), kinetic time (K), α-angle (AA), maximum amplitude (MA), coagulation index (CI), and lysis index (LY30)] at admission and at 7-14 days after treatment. CI < -3 represents hypocoagulable state. Clinical profile including systemic inflammatory response syndrome (SIRS), infection severity, bleeding, treatment response, and outcome were noted.
Results:
Thirty children (21 boys, median (IQR) age 78 [15.7-180] months) were studied prospectively. At admission, 29 (96.7%) had prolonged INR, 24 (80%) had thrombocytopenia, and 17 (56.6%) were hypocoagulable by TEG. Nine of 30 (30%) had normal TEG but deranged INR and platelets. Nineteen (63.3%) cases had SIRS, 11 (36.6%) had severe sepsis, and 8 (26.6%) had bleeding. Hypocoagulable state was common in severe sepsis than sepsis/infection (81.1% versus 42.1%; P = 0.05) and persistent (n = 4) versus recovered SIRS (n = 15, 100% versus 33%; P = 0.03). Bleeders had prolonged R-time (7.8 versus 5.4 min; P = 0.03), smaller MA (30.2 versus 47 mm; P = 0.05), and α-angle (40.4 versus 62.9; P = 0.03) but similar INR and platelets than nonbleeders. Six patients (20%) had poor in-hospital outcomes; R-time ≥8.5 min predicted mortality with high sensitivity (83%) and specificity (100%).
Conclusions:
Fifth-seven percent of children with DCLD and infection were hypocoagulable by TEG. Severe sepsis and persistent SIRS worsened the coagulation status. TEG identifies bleeders better than INR and platelet count. R-time ≥8.5 min predicts a poor hospital outcome.
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