中文｜English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 42 Issue 1
Jan.  2026
Turn off MathJax
Article Contents
Article Navigation >  Journal of Clinical Hepatology  > 2026  >  42(1): 111-116

Thromboelastographic features of patients with primary liver cancer and their value in assessing coagulation function

DOI: 10.12449/JCH260113
  • 1.

    Department of Surgical Intensive Care Unit，The First Affiliated Hospital of Xi’an Jiaotong University，Xi’an 710061，China

  • 2.

    Department of Hepatobiliary Surgery，The First Affiliated Hospital of Xi’an Jiaotong University，Xi’an 710061，China

Research funding:

Shaanxi Provincial Key Research and Development Program (2022SF-374)

More Information
  • Corresponding author: WANG Zheng， zheng.wang11@mail.xjtu.edu.cn （ORCID： 0000-0002-0490-466X）
  • Received Date: 2025-04-22
  • Accepted Date: 2025-10-10
  • Published Date: 2026-01-25
    Abstract
  •   Objective  To investigate the clinical application value of thromboelastographic parameters in assessing coagulation function by analyzing the thromboelastographic features of patients with primary liver cancer （PLC）， and to provide a basis for coagulation management and prognostic evaluation in liver cancer patients.  Methods  A retrospective analysis was performed for 1 253 PLC patients who were admitted to The First Affiliated Hospital of Xi’an Jiaotong University from May 2015 to December 2022. According to the presence or absence of cirrhosis， the patients were divided into non-cirrhosis group with 262 patients and cirrhosis group with 991 patients， and according to the presence or absence of HBV infection， they were divided into HBV infection group with 1 055 patients and non-HBV infection group with 198 patients. The patients were stratified based on the severity of liver cirrhosis （Child-Pugh class and MELD score） and liver reserve function （indocyanine green retention rate at 15 minutes ［ICGR15］）， and thromboelastography was used to measure thromboelastographic parameters （reaction time ［R］， coagulation formation time ［K］， α-angle， maximum thrombosis amplitude ［MA］， and coagulation composite index ［CI］） and conventional coagulation markers. The t-test was used for comparison of normally distributed continuous data between two groups； a one-way analysis of variance was used for comparison between multiple groups， and the least significant difference t-test was used for further comparison between two groups. The Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups； the Kruskal-Wallis H test was used for comparison between multiple groups， and the Bonferroni correction method was used for further comparison between two groups. The chi-square test was used for comparison of categorical data between grouips， and the Spearman test was used for correlation analysis.  Results  Among the 991 patients in the cirrhosis group， 826 had Child-Pugh class A （5 — 6 points）， and 165 had Child-Pugh class B （7 — 9 points）； 812 had an MELD score of <10， and 179 had an MELD score of ≥10； 679 had an ICGR15 of <10%， and 294 had an ICGR15 of ≥10%. Compared with the patients with Child-Pugh class A， the patients with Child-Pugh class B had a significantly longer K time and significant reductions in α-angle， MA， and CI （all P <0.001）； compared with the MELD score <10 group， the MELD score ≥10 group had a significantly longer K time and significant reductions in α-angle， MA， and CI （all P<0.001）； compared with the ICGR15 <10% group， the ICGR15 ≥10% group had a significantly longer K time and a significant reduction in MA （both P <0.001）. Among the 1 253 patients， MA was strongly positively correlated with fibrinogen and platelet count （r=0.675 and 0.667， both P<0.001）； The MA had a weak correlation with Child-Pugh score， MELD score， and ICGR15 （r=-0.112， -0.250， and -0.117， all P<0.001）， while the K time，α-angle and CI were weakly correlated with the MELD score （r=0.222， -0.184， and -0.183， all P<0.001），R time was negatively correlated with ICGR15 （r=-0.080， P=0.005）. The HBV infection group had significantly higher MA and CI than the non-HBV infection group （P<0.05）.  Conclusion  Thromboelastography can sensitively identify the hypocoagulable state associated with the progression of liver cirrhosis and the hypercoagulable tendency in HBV-related liver cancer， which provides an important reference for individualized anticoagulant therapy in clinical practice.

     

    • FullText(HTML)
  • loading
    • References(22)
  • [1]
    SUNG H, FERLAY J, SIEGEL RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71( 3): 209- 249. DOI: 10.3322/caac.21660.
    [2]
    ANANTHAKRISHNAN A, GOGINENI V, SAEIAN K. Epidemiology of primary and secondary liver cancers[J]. Semin Intervent Radiol, 2006, 23( 1): 47- 63. DOI: 10.1055/s-2006-939841.
    [3]
    CHEN CJ, YANG HI, ILOEJE UH, et al. Hepatitis B virus DNA levels and outcomes in chronic hepatitis B[J]. Hepatology, 2009, 49( 5 Suppl): S72- S84. DOI: 10.1002/hep.22884.
    [4]
    TRIPODI A, PRIMIGNANI M, CHANTARANGKUL V, et al. Thrombin generation in patients with cirrhosis: The role of platelets[J]. Hepatology, 2006, 44( 2): 440- 445. DOI: 10.1002/hep.21266.
    [5]
    LISMAN T, PORTE RJ. Rebalanced hemostasis in patients with liver disease: Evidence and clinical consequences[J]. Blood, 2010, 116( 6): 878- 885. DOI: 10.1182/blood-2010-02-261891.
    [6]
    GUO R, XIE Y, YANG J, et al. Increasing plasma ADAMTS13 activity is associated with HBeAg seroconversion in chronic hepatitis B patients during 5 years of entecavir treatment[J]. Sci Rep, 2019, 9( 1): 5916. DOI: 10.1038/s41598-019-42421-5.
    [7]
    GALLI L, GERDES VE, GUASTI L, et al. Thrombosis associated with viral hepatitis[J]. J Clin Transl Hepatol, 2014, 2( 4): 234- 239. DOI: 10.14218/JCTH.2014.00031.
    [8]
    de PIETRI L, BIANCHINI M, MONTALTI R, et al. Thrombelastography-guided blood product use before invasive procedures in cirrhosis with severe coagulopathy: A randomized, controlled trial[J]. Hepatology, 2016, 63( 2): 566- 573. DOI: 10.1002/hep.28148.
    [9]
    WANG SC, SHIEH JF, CHANG KY, et al. Thromboelastography-guided transfusion decreases intraoperative blood transfusion during orthotopic liver transplantation: Randomized clinical trial[J]. Transplant Proc, 2010, 42( 7): 2590- 2593. DOI: 10.1016/j.transproceed.2010.05.144.
    [10]
    SHIN KH, KIM IS, LEE HJ, et al. Thromboelastographic evaluation of coagulation in patients with liver disease[J]. Ann Lab Med, 2017, 37( 3): 204- 212. DOI: 10.3343/alm.2017.37.3.204.
    [11]
    GOYAL S, JADAUN S, KEDIA S, et al. Thromboelastography parameters in patients with acute on chronic liver failure[J]. Ann Hepatol, 2018, 17( 6): 1042- 1051. DOI: 10.5604/01.3001.0012.7205.
    [12]
    THAKRAR SV, MALLETT SV. Thrombocytopenia in cirrhosis: Impact of fibrinogen on bleeding risk[J]. World J Hepatol, 2017, 9( 6): 318- 325. DOI: 10.4254/wjh.v9.i6.318.
    [13]
    HUGENHOLTZ GCG, ADELMEIJER J, MEIJERS JCM, et al. An unbalance between von Willebrand factor and ADAMTS13 in acute liver failure: Implications for hemostasis and clinical outcome[J]. Hepatology, 2013, 58( 2): 752- 761. DOI: 10.1002/hep.26372.
    [14]
    WEISEL JW, LITVINOV RI. Fibrin formation, structure and properties[J]. Subcell Biochem, 2017, 82: 405- 456. DOI: 10.1007/978-3-319-49674-0_13.
    [15]
    AMBROSINO P, TARANTINO L, DI MINNO G, et al. The risk of venous thromboembolism in patients with cirrhosis. A systematic review and meta-analysis[J]. Thromb Haemost, 2017, 117( 1): 139- 148. DOI: 10.1160/TH16-06-0450.
    [16]
    INTAGLIATA NM, CALDWELL SH, TRIPODI A. Diagnosis, development, and treatment of portal vein thrombosis in patients with and without cirrhosis[J]. Gastroenterology, 2019, 156( 6): 1582- 1599.e1. DOI: 10.1053/j.gastro.2019.01.265.
    [17]
    NORTHUP PG, CALDWELL SH. Coagulation in liver disease: A guide for the clinician[J]. Clin Gastroenterol Hepatol, 2013, 11( 9): 1064- 1074. DOI: 10.1016/j.cgh.2013.02.026.
    [18]
    ZHU AX, KUDO M, ASSENAT E, et al. Effect of everolimus on survival in advanced hepatocellular carcinoma after failure of sorafenib: The EVOLVE-1 randomized clinical trial[J]. JAMA, 2014, 312( 1): 57- 67. DOI: 10.1001/jama.2014.7189.
    [19]
    KOZEK-LANGENECKER SA, AFSHARI A, ALBALADEJO P, et al. Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology[J]. Eur J Anaesthesiol, 2013, 30( 6): 270- 382. DOI: 10.1097/EJA.0b013e32835f4d5b.
    [20]
    LIU B, ZHANG Q, ZHANG J. Guiding role of thromboelastography in clinical blood transfusion in patients with coagulation dys function after liver cancer surgery and its effect on coagulation indexes and blood coagulation quality[J]. J Clin Exp Med, 2025, 24( 7): 754- 758. DOI: 10.3969/j.issn.1671-4695.2025.07.021.

    刘波, 张群, 张杰. 血栓弹力图在肝癌术后伴凝血功能异常患者临床输血中的指导作用及对凝血指标和血凝质量的影响[J]. 临床和实验医学杂志, 2025, 24( 7): 754- 758. DOI: 10.3969/j.issn.1671-4695.2025.07.021.
    [21]
    TIAN L, TANG S, WANG N, et al. Hepatic and portal vein Doppler ultrasounds in assessing liver inflammation and fibrosis in chronic HBV infection with a normal ALT level[J]. Front Med(Lausanne), 2023, 10: 1178944. DOI: 10.3389/fmed.2023.1178944.
    [22]
    ZHU Z, YU Y, KE Y, et al. Thromboelastography maximum amplitude predicts short-term mortality in patients with hepatitis B virus-related acute-on-chronic liver failure[J]. Exp Ther Med, 2020, 20( 3): 2657- 2664. DOI: 10.3892/etm.2020.8990.
    • Relative Articles
    • Supplements(0)
    • Cited By
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Tables(7)

    Get Citation
    PDF
    XML

    Article Metrics

    Article views (76) PDF downloads(40) Cited by()
    Proportional views
    Related
        

    The first journal specializing in hepatobiliary and pancreatic diseases in China

    Supervisor：Ministry of Education of the People's Republic of China

    Sponsor：Jilin University

    Academic Support: Chinese Society of Hepatology，Chinese Medical Association

    Address: 461 Xinjiang Road, Changchun

    Submit：0431-88782044

    Peer review：0431-88783542

    Email：lcgdb@vip.163.com

    About Journal

    Submission Guideline

    Journal Online

    Hepatobiliary College

    Guidelines

    YesterdayIP[]YesterdayPV[]TodayIP[]TodayPV[]Online[]

    Website Design © 2020 Editorial Board of Journal of Clinical Hepatology 吉ICP备10000617号-1 Supported by: Beijing Renhe Information Technology Co. Ltd  

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return