MỐI LIÊN QUAN GIỮA BIẾN ĐỔI CHỈ SỐ PHÂN TÍCH DẠNG SÓNG CỤC MÁU ĐÔNG VỚI TÌNH TRẠNG RỐI LOẠN ĐÔNG MÁU Ở BỆNH NHÂN SUY GAN CẤP

Abstract

Objective: To describe the relationship between changes in clot waveform analysis (CWA) and coagulation disorders in patients with acute liver failure (ALF). Subjects and Methods: A study was carried on 40 patients with acute liver failure (ALF) treated at the Center for Critical care medicine of Bach Mai Hospital from July 2023 to July 2024. Blood samples were collected on admission before the use of anticoagulants and were analyzed using the CS 5100 machine and Dade Actin FSL reagent. The values of the clot waveform analysis (CWA), including min1, min2, max2; Coagulation disorders: clinical bleeding, bleeding prediction scales (IMPROVE) and venous thromboembolism (PADUA) were recorded. CWA data was analyzed for correlation with coagulation disorders at the time of admission by using medical statistical software. Results: The male ratio was higher than female, accounting for 70%, with an average age of 55.2 ± 15.5 (23-82). The highest rate of gastrointestinal bleeding was 25%, the rate of subcutaneous bleeding was 20%, and other locations such as in the muscles, eyes, and urinary tract were 7.5%. The mean values of CWA: min1: 3.02±1.38; min2: 0.47±0.25; max2: 0.43±0.27 were lower than the reference range. Area under the ROC curve: ​​min1 (AUC=0.81), min2 (AUC=0.78) and max2 (AUC=0.84) were significant in predicting bleeding (p<0.05). The group of patients with IMPROVE score ≥7 had average values ​​of min1: 2.69±1.42, min2: 0.40±0.26, max2: 0.38±0.29 lower than the group with IMPROVE score <7: 3.87±0.8; 0.58±0.16; 0.56±0.12(p<0.05). The values min1, min2, max2 were positively correlated with Fibrinogen index (r= 0.78; r=0.65; r=0.46; p<0.05), in patients with PADUA score ≥ 4 only min1 was higher than the PADUA <4 group (3.72±0.82 compared to 2.79±1.46) and was significant with p<0.05. Conclusions: The mean values of CWA ​​in ALF patients decreased compared to the reference range and were associated with clinical bleeding, which was significant in predicting bleeding. Only min1 increased significantly and significantly in the group at risk of venous thromboembolism.