Coagulation failure is associated with bleeding events and clinical outcome during systemic inflammatory response and sepsis in acute-on-chronic liver failure: An observational cohort study.

摘要: Background Patients with acute-on-chronic liver failure (ACLF) have coagulation in the setting of systemic inflammatory syndrome (SIRS), sepsis and extra-hepatic organ failures. Methods Consecutive ACLF patients without at baseline were assessed days 0, 3 7 thromboelastography (TEG) specific assays (Factor VIII, von Willebrand factor [vWF], protein C antithrombin III [ATIII]) followed for development sepsis, bleeding outcome. Results Of 243 patients, 114 (63% ethanol related; mean age 44.3 ± 11.7 years; 90% male) recruited. SIRS was noted 39 (34.2%), 45 (39.5%) 46 (40%) 28 (24%) 52 (56.1%) respectively. The 28- 90-day survivals 62% 51% A hypocoagulable TEG a predictor (hazard ratio [HR] 2.1; CI 1.6-4.9; P = 0.050) mortality (HR 1.9; 1.3-7.9; 0.043). had increased Factor vWF, tissue levels plasminogen activator (tPA) activity reduced ATIII. Coagulation parameters like Index 1.1-4.5; 0.044),clot lysis 3.2; 1.9-3.4; 0.033), low 20 ng/mL 1.2; 1.1-2.1; 0.040) predicted when adjusted age, gender MELD. Conclusions Dynamic derangements, measured by TEG, determine likelihood ACLF.