Coagulation parameters and major bleeding in critically ill patients with cirrhosis

TY - JOUR

T1 - Coagulation parameters and major bleeding in critically ill patients with cirrhosis

AU - Drolz, Andreas

AU - Horvatits, Thomas

AU - Roedl, Kevin

AU - Rutter, Karoline

AU - Staufer, Katharina

AU - Kneidinger, Nikolaus

AU - Holzinger, Ulrike

AU - Zauner, Christian

AU - Schellongowski, Peter

AU - Heinz, Gottfried

AU - Perkmann, Thomas

AU - Kluge, Stefan

AU - Trauner, Michael

AU - Fuhrmann, Valentin

N1 - © 2016 by the American Association for the Study of Liver Diseases.

PY - 2016/8

Y1 - 2016/8

N2 - Background and rationale Disturbances of coagulation and hemostasis are common in patients with liver cirrhosis. The typical laboratory pattern mimics disseminated intravascular coagulation (DIC). Aim of this study was to assess the impact of routine coagulation parameters in critically ill cirrhotic patients with regards to new onset of major bleeding and outcome. Methods A total of 1493 critically ill patients were studied prospectively. Routine coagulation parameters were assessed and the DIC score was calculated based on platelets (PLT), fibrinogen, d-dimer, and prothrombin index (PI). New onset of major bleeding during the stay at the ICU and mortality were assessed. Patients were followed for 1 year. Main results Two hundred eleven patients of the cohort had liver cirrhosis. PLT, fibrinogen, PI, activated partial thromboplastin time (aPTT) and d-dimer as well as the DIC score differed significantly between patients with and without cirrhosis (p<0.001 for all). Moreover, fibrinogen, PLT and aPTT (but not PI) differed significantly between cirrhotic patients with and without major bleeding (p<0.01 for all). Bleeding on admission, platelet counts<30 10(9) /l, fibrinogen levels<60 mg/dl and aPTT values >100s were strongest independent predictors for new onset of major bleeding in multivariate regression analysis. One-year-mortality in cirrhotic patients with and without major bleeding was 89% and 68%, respectively (p<0.05 between groups). Conclusion Abnormal coagulation parameters and high DIC scores (primarily due to fibrinogen and platelets) correspond to increased bleeding risk in patients with liver cirrhosis at the ICU. Fibrinogen and platelet count were identified as best routine coagulation parameters for prediction of new onset of major bleeding. However, further studies are required to evaluate potential therapeutic implications of these findings. This article is protected by copyright. All rights reserved.

AB - Background and rationale Disturbances of coagulation and hemostasis are common in patients with liver cirrhosis. The typical laboratory pattern mimics disseminated intravascular coagulation (DIC). Aim of this study was to assess the impact of routine coagulation parameters in critically ill cirrhotic patients with regards to new onset of major bleeding and outcome. Methods A total of 1493 critically ill patients were studied prospectively. Routine coagulation parameters were assessed and the DIC score was calculated based on platelets (PLT), fibrinogen, d-dimer, and prothrombin index (PI). New onset of major bleeding during the stay at the ICU and mortality were assessed. Patients were followed for 1 year. Main results Two hundred eleven patients of the cohort had liver cirrhosis. PLT, fibrinogen, PI, activated partial thromboplastin time (aPTT) and d-dimer as well as the DIC score differed significantly between patients with and without cirrhosis (p<0.001 for all). Moreover, fibrinogen, PLT and aPTT (but not PI) differed significantly between cirrhotic patients with and without major bleeding (p<0.01 for all). Bleeding on admission, platelet counts<30 10(9) /l, fibrinogen levels<60 mg/dl and aPTT values >100s were strongest independent predictors for new onset of major bleeding in multivariate regression analysis. One-year-mortality in cirrhotic patients with and without major bleeding was 89% and 68%, respectively (p<0.05 between groups). Conclusion Abnormal coagulation parameters and high DIC scores (primarily due to fibrinogen and platelets) correspond to increased bleeding risk in patients with liver cirrhosis at the ICU. Fibrinogen and platelet count were identified as best routine coagulation parameters for prediction of new onset of major bleeding. However, further studies are required to evaluate potential therapeutic implications of these findings. This article is protected by copyright. All rights reserved.

U2 - 10.1002/hep.28628

DO - 10.1002/hep.28628

M3 - SCORING: Journal article

C2 - 27124745

VL - 64

SP - 556

EP - 568

JO - HEPATOLOGY

JF - HEPATOLOGY

SN - 0270-9139

IS - 2

ER -