Thromboelastograhpy of hemostasis in hepatocellular carcinoma with underlying cirrhosis and massive intraoperative blood loss in liver resection

Abstract

Abstract Objects The presence of underlying cirrhosis in patients with hepatocellular carcinoma (HCC) might further complicate hemostasis. Thromboelastography (TEG) is a global coagulation test that accurately reflects hemostatic function in patients with liver cirrhosis. Therefore, we aimed to explore the association between TEG parameters and HCC with underlying cirrhosis or massive intraoperative blood loss during liver resection. Methods Demographic, clinical, and laboratory data of adult HCC patients who underwent TEG prior to live resection or any blood transfusions were collected. The clinical severity of cirrhosis was categorized. Liver resections were classified into low, medium, and high complexity. Results A total of 833 patients with HCC were included. There was a longer K-times (2.43 ± 0.98 vs. 1.92 ± 0.79, p < 0.001), smaller α‑angles (60.32 ± 11.33 vs. 64.69 ± 7.77, p < 0.001), lower maximum amplitude (MA) (55.32 ± 8.06 vs. 61.38 ± 7.66, p < 0.001) in cirrhotic patients than those non-cirrhotic patients. After multivariate adjusted logistic analysis, the lower MA (OR = 0.947, 95%CI, 0.916–0.980, p = 0.002) was still associated with cirrhosis. Furthermore, the AUC of the MA for predicting cirrhosis was 0.710 (95% CI, 0.666–0.754, p < 0.001). The association between MA and clinical cirrhosis severity was also statistically significant but weak (r=-0.068, p = 0.020). There were no significantly differences between patient with and without massive intraoperative blood loss regarding TEG parameters (all p > 0.05). After multivariate adjusted analysis, the CTP class B (OR = 2.274, 95%CI, 1.424–3.630, p = 0.001), open surgery (OR = 2.668, 95%CI, 1.780–3.998, p < 0.001), and more surgery complexity (medium, OR = 2.663, 95%CI, 1.091-6.500, p = 0.031; high, OR = 4.425, 95%CI, 1.695–11.552, p = 0.002) was independently associated with massive intraoperative blood loss. Conclusions The results of present study implied that though the MA was associated with cirrhosis, it could not discriminate the stage of cirrhosis in patients with HCC. Preoperative TEG parameters could not predict intraoperative massive blood loss in HCC with underlying cirrhosis.