Original article

Blood Transfusion - 3 2019 (May-June)

Fibrinogen measurement in liver disease: validation of the functional fibrinogen thromboelastography assay and a novel mathematical predictive model

Authors

Key words: fibrinogen, functional fibrinogen, cirrhosis, linear regression model
Publication Date: 2018-11-09

Abstract

Background. Fibrinogen is produced in the liver and tends to be reduced in liver cirrhosis. Quantitative and qualitative tests exist to measure fibrinogen. We aimed to validate the functional fibrinogen thromboelastography assay (FF-TEG) and propose a new model to estimate fibrinogen levels via the Clauss method (Clauss) using data from a prothrombin time-derived fibrinogen assay (PT-Fg) in patients with liver cirrhosis.
Materials and methods. Clauss, PT-Fg, fibrinogen antigen (Fib-Ag) and FF-TEG were studied in 55 patients with liver cirrhosis (26 with Child-Turcotte-Pugh [CTP]-A disease, 14 with CTP-B and 15 CTP-C) and 20 healthy individuals.
Results. The results of all four assays correlated strongly with each other, but gave significantly different mean levels in all cohorts. PT-Fg gave the highest levels whereas the Clauss gave the lowest levels. The FF-TEG performed well with results which were in between the Clauss and the PT-Fg. Significant differences were only observed between CTP-A and CTP-C for the Clauss, PT-Fg and Fib-Ag but not functional fibrinogen level. We devised a simple linear regression model in order to estimate Clauss from the PT-Fg.
Discussion. The results of the FF-TEG correlate well with those of routine fibrinogen assays in patients with liver cirrhosis. However, the FF-TEG assay does not discriminate between early and late stages of disease, pointing to a preserved fibrin clot strength in cirrhosis. Through linear regression models, fibrinogen levels can be accurately estimated using the Clauss method based on fibrinogen levels obtained in the cheaper PT-Fg.

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Authors

Kirsty Rizzo - Faculty of Health Sciences, University of Malta, Tal-Qroqq, Msida

Kevin Vella - Coagulation Laboratory, Department of Pathology, "Mater Dei" Hospital, Msida

Daniel Zammit - Coagulation Laboratory, Department of Pathology, "Mater Dei" Hospital, Msida

Peter Gatt - Clinical Perfusion Services, Department of Cardiac Surgery, "Mater Dei" Hospital, Msida

Charlie Grima - Clinical Perfusion Services, Department of Cardiac Surgery, "Mater Dei" Hospital, Msida

Monique Borg Inguanez - Department of Statistics and Operations Research, University of Malta, Tal-Qroqq, Msida; 5Division of Gastroenterology, "Mater Dei" Hospital, Msida

Jurgen Gerada - Division of Gastroenterology, "Mater Dei" Hospital, Msida

Pierre x Pierre Ellul - Division of Gastroenterology, "Mater Dei" Hospital, Msida

Mario Vassallo - Division of Gastroenterology, "Mater Dei" Hospital, Msida

Mario Vassallo - Division of Gastroenterology, "Mater Dei" Hospital, Msida

Neville Azzopardi - Division of Gastroenterology, "Mater Dei" Hospital, Msida

James Pocock - Division of Gastroenterology, "Mater Dei" Hospital, Msida

Alex Gatt - Coagulation Laboratory, Department of Pathology, "Mater Dei" Hospital, Msida; Department of Pathology, University of Malta, Tal-Qroqq, Msida, Malta

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