The role of thromboelastogram (TEG) and routine coagulation indexes in evaluating the severity of acute pancreatitis in the early stage of onset

To study the role of thromboelastogram (TEG) and routine coagulation indexes in evaluating the severity of acute pancreatitis (AP) in the early stage of onset. A total of 123 patients with acute pancreatitis treated at our hospital from January 2018 to January 2021 were divided into three groups according to their disease severity. We analyzed the correlation and prognostic significance of TEG, routine coagulation indexes and blood platelet (PLT) count with disease severity. The clot reaction time (R-value), clot generation time (K-value), maximum width value (MA-value) and clot generation rate (α-angle) between the three groups were significantly different (p < 0.05). The level of prothrombin time (PT), D-dimer (D-D) and fibrinogen (FIB) and PLT count of the mild group were significantly different from the moderate and severe group as well as between the moderate and severe group (p < 0.05). Spearman correlation analysis showed that α-angle, MA-value, PT, D-D, activated partial thromboplastin time (APTT) and FIB were positively correlated, while platelet count, R-value and K-value were negatively correlated with the severity of AP. According to the follow-up results, 110 patients were divided into the survival (n = 95) or the death (n = 15) group. The R- and K-values in the survival group were significantly higher than those in the death group, while the α angle, MA-value, PT, APTT, D-D and FIB in the death group were significantly lower than those in the death group (p < 0.05). The severity and prognosis of patients with AP were directly related to the degree of coagulation disorder, and TEG combined with routine coagulation indexes demonstrated high evaluation significance for determining the severity and prognosis of AP patients.

Thromboelastogram; Routine coagulation indexes; Acute pancreatitis; Severity of disease

[1] Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, et al. Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013; 62: 102–111.

[2] Wang G, Gao C, Wei D, Wang C, Ding S. Acute pancreatitis: etiology and common pathogenesis. World Journal of Gastroenterology. 2009; 15: 1427.

[3] Garg PK, Singh VP. Organ failure due to systemic injury in acute pancreatitis. Gastroenterology. 2019; 156: 2008–2023.

[4] Mederos MA, Reber HA, Girgis MD. Acute pancreatitis. JAMA. 2021; 325: 382.

[5] Dumnicka P, Maduzia D, Ceranowicz P, Olszanecki R, Drożdż R, Kuśnierz-Cabala B. The interplay between inflammation, coagulation and endothelial injury in the early phase of acute pancreatitis: clinical implications. International Journal of Molecular Sciences. 2017; 18: 354.

[6] Fan C, Song Y, Wang X, Mao C, Xiong Y. Identification of early derangements of coagulation, hematological and biochemical profiles in patients with acute pancreatitis. Clinical Biochemistry. 2022; 109–110: 37–43.

[7] Li Q, Liu C, Ling L, Huang X, Chen S, Zhou J. Association between coagulation function and prognosis in patients with acute pancreatitis. Nan Fang Yi Ke Da Xue Xue Bao. 2022; 42: 1006–1012. (In Chinese)

[8] Badhal SS, Sharma S, Saraya A. Prognostic significance of D-dimer, natural anticoagulants and routine coagulation parameters in acute pancreatitis. Tropical Gastroenterology. 2012; 33: 193–199.

[9] Liu C, Zhou X, Ling L, Chen S, Zhou J. Prediction of mortality and organ failure based on coagulation and fibrinolysis markers in patients with acute pancreatitis. Medicine. 2019; 98: e15648.

[10] Othman M, Kaur H. Thromboelastography (TEG). Methods in Molecular Biology. 2017; 26: 533–543.

[11] Whiting D, DiNardo JA. TEG and ROTEM: technology and clinical applications. American Journal of Hematology. 2014; 89: 228–232.

[12] Florkiewicz H, Korolko A, Bielak J. Blood clotting disorders in acute pancreatitis. Polski Tygodnik Lekarski. 1969; 24: 521–523. (In Polish)

[13] Fan C, Song Y, Wang X, Mao C, Xiong Y. Identification of early derangements of coagulation, hematological and biochemical profiles in patients with acute pancreatitis. Clinical Biochemistry. 2022; 109–110: 37–43.