Efficacy of Thromboelastography in Predicting the Complications and Outcomes in Patients Admitted to Intensive Care Unit with Liver Disease: A Prospective Observational Study

BACKGROUND: Thromboelastography (TEG) provides a comprehensive assessment of the balance between pro-coagulants and anticoagulants in patients with liver disease. Although TEG is well-validated and widely used in the operating room, its application in the intensive care unit (ICU) remains underutilized. TEG demonstrates the ability to predict complications such as gastrointestinal bleeding, infection, and overall outcomes. Hence, this study aimed to evaluate the efficacy of TEG in predicting complications and outcomes in critically ill patients with liver disease. METHODS: This prospective observational cohort study was conducted from august 2023 to November 2024. We included critically ill adults with acute-on-chronic or chronic liver disease admitted to the liver ICU in whom TEG was performed within 24 hours of admission. The primary objective was to assess the predictive value of TEG for complications and mortality in these patients. RESULTS: Of the 74 patients enrolled in this study till today. 33 patients had normal TEG, whereas 41 patients had abnormal TEG. Baseline SOFA scores were significantly higher in the abnormal TEG group (10.4 ± 5.93) compared to the normal TEG group (7.94 ± 3.52) (p = 0.042). In our study, 49 Out of 74 patients presented with upper gastrointestinal bleeding during admission. The baseline TEG parameters between bleeding and non bleeding patients were comparable. In multi variate regression analysis, we found an independent association between rebleeding and 28 day all cause mortality in CLD patients (OR = 7.98, 95% CI:1.59-40.0, p = 0.012). CONCLUSION: Abnormal TEG parameters was not associated with significant rebleeding in acute on chronic liver failure or CLD patients. TEG may not be a good predictor of mortality in critically ill patients with liver disease. Further studies are warranted to explore its role in guiding clinical decision-making in this population.