Design for a Multicentre Prospective Cohort for the Assessment of Platelet Function in Patients with Hepatitis-B-Virus-Related Acute-on-Chronic Liver Failure

Abstract

Background: Acute-on-chronic liver failure (ACLF) has high short-term mortality and lacks sufficient medical therapy. Available algorithms are unable to precisely predict short-term outcomes or safely stratify patients with ACLF as emergent liver transplantation candidates. Therefore, a personalized prognostic tool is urgently needed. Purpose: Platelet function and its clinical significance in ACLF patients with chronic hepatitis B virus (HBV) infection have not been investigated. This study aimed to assess changes in platelet function using thromboelastography (TEG) and platelet mapping (TEG-PM) in HBV-related ACLF patients. Methods: Chronic liver disease patients with acute decompensation or acute hepatic injury were recruited. The derivation cohort enrolled HBV-related patients at Nanfang Hospital. HBV-related and non-HBV-related patients were both enrolled in internal and external validation cohorts at seven university hospitals. TEG and TEG-PM were performed at baseline in the derivation cohort and baseline, day 7, and day 14 in the validation cohorts. The primary outcome was all-cause 28-day mortality. Status check and new-onset complications were recorded during the 3-month follow-up, but status check will extend to 5 years. Conclusion and Future Plans:In this study, 586 participants were enrolled, including 100 in derivation cohort, 133 in internal validation cohort, and 353 in external validation cohort. Biomaterials, including plasma, serum, urine, and some explanted liver tissues, were collected from these patients. A 3-month follow-up with survival status was completed. The baseline characteristics indicated that 51% of the patients had adenosine diphosphate (ADP)-hyporesponsive circulating platelets. The prognostic potential of platelet function will be explored in the derivation cohort (HBV-related ACLF patients) and further substantiated in the validation cohorts (HBV-related and non-HBV-related ACLF patients). Biosamples are currently used to explore the underlying mechanisms related to ADP-hyporesponsive platelets. The ongoing proteomic and metabolic analyses will provide new insights into the pathogenesis of extrahepatic organ failures in ACLF patients.

Viscoelastic coagulation monitoring parameters in cats with acute arterial thromboembolism

“…Moreover, a previous investigation 14 showed moderate to good correlation between the 2 VCM‐Vet devices used, and some reported technical issues make it challenging to adequately interpret the results. In our study, we elected to use an established reference interval, as well as a control group, for data interpretation, which is commonly done in people in multicenter studies involving TEG 34 , 35 , 36 , 37 , 38 or ROTEM. 35 , 36 , 39 The data also was assessed for interlaboratory instrument variability across the 2 institutions.…”

High Systemic Immune-Inflammation Index, Predicting Early Allograft Dysfunction, Indicates High 90-Day Mortality for Acute-On-Chronic Liver Failure after Liver Transplantation

“…Through univariate and multivariate analyses, we found that SII ≥201.5 and MELD ≥27 were independent prognostic factors for 90-day mortality after surgery. Similarly, Lin et al [28] found that high neutrophil-lymphocyte ratio indicates poor prognosis for ACLF after LT. Jiang et al [29] revealed that platelet function is a prognostic marker in ACLF.…”

“…Through univariate and multivariate analyses, we found that SII ≥201.5 and MELD ≥27 were independent prognostic factors for 90-day mortality after surgery. Similarly, Lin et al [28] found that high neutrophil-lymphocyte ratio indicates poor prognosis for ACLF after LT. Jiang et al [29] revealed that platelet function is a prognostic marker in ACLF. SII, systemic immune-inflammation index; BMI, body mass index; WBC, white blood cell; Hb, hemoglobin; ALT, alanine aminotransferase; AST, aspartate aminotransferase; GGT, glutamyl transpeptidase; TB, total bilirubin; Crea, creatinine; MELD, model for end-stage liver disease score; Child, Child-Pugh scores; operation time, operation time was defined a priori as the total duration in the operating room [24]; anhepatic phase, anhepatic phase was defined from the time the cava was clamped and the liver was removed to the time that liver was perfused [25]; blood loss, blood loss was calculated as the sum of blood collected in the cell saver, in other suction systems, and that estimated to be contained in cotton swabs and compresses minus the recorded volume of fluid used to flush the surgical site and the cell-saver collection system [26]; DBD, donation after brain death; DCD, donation after cardiac death.…”