RESUMO
@#Abstract: Objective To analyze the correlation between the thromboelastography (TEG) indexes and the indexes related to liver injury in patients with heat stroke, and explore the diagnostic value of TEG indexes for liver injury in patients with heat stroke. Methods A total of 95 patients with exertional heat stroke (EHS) admitted to 924 Hospital of the Joint Service Support Force of the People's Liberation Army of China from August 2020 to July 22 were selected, and divided into a non-liver injury group (55 cases) and a liver injury group (40 cases) according to whether there was liver injury. TEG instrument was used for the detection of thromboelastography to record the TEG parameters, including reaction time (R), agglutination time (K), α angle, maximum amplitude (MA value), and coagulation complex index (CI). The levels of glutamic transaminase (AST), alanine aminotransferase (ALT), total bilirubin (TBil), albumin (ALB) were detected by automatic biochemical analyzer. Pearson's method was applied to analyze the correlation between thromboelastography indexes R, K, α angle, CI and liver function indexes AST, ALT, TBil, ALB in patients with heat stroke after liver injury. Receiver operating characteristic curve (ROC) was applied to analyze the predictive value of thromboelastography indexes R, K, α angle, CI and combined detection for liver injury in patients with heat stroke. Results Compared with the non-liver injury group, the AST, ALT and TBil levels in patients with heat stroke in the liver injury group were higher (t=26.174, 16.923, 18.414, P<0.05), while the ALB level was lower (t=24.596, P<0.05); compared with the non-liver injury group, the R and K of patients with heat stroke in the liver injury group were higher (t=58.014, 52.862, P<0.05), and the α angle and CI were lower (t=46.853, 60.717, P<0.05); R was positively correlated with AST and ALT (r=0.532, 0.610, P<0.001), and negatively correlated with ALB (r=-0.551, P<0.001) in patients with heat stroke complicated with liver injury; K was positively correlated with AST, ALT and TBil (r=0.661, 0.531, 0.504, P<0.001); α angle was negatively correlated with AST and ALT (r=-0.473, -0.448, P<0.01), and positively correlated with ALB (r=0.539, P<0.001); CI was negatively correlated with AST, ALT and TBil (r=-0.458, -0.505, -0.549, P<0.001); the area under the curve (AUC) of thromboelastography indexes R, K, α angle and CI in predicting liver injury in patients with heat stroke was 0.807 (sensitivity of 70.0%, specificity of 81.6%), 0.831 (sensitivity of 77.5%, specificity of 85.5%), 0.747 (sensitivity of 67.5%, specificity of 74.5%), and 0.788 (sensitivity of 77.5%, specificity of 83.6%), respectively. The AUC of combined detection to predict liver injury in patients with heat stroke was 0.967 (sensitivity of 92.5%, specificity of 91.9%). Conclusions The thromboelastography indexes are correlated with the indexes related to liver injury in patients with heat stroke, and the thromboelastography indexes are helpful to diagnose liver injury in patients with heat stroke.