Thromboelastographic Parameters in Patients with Primary Liver Cancer: Clinical Characteristics and Value in Assessing Coagulation Function

Thromboelastographic Parameters in Patients with Primary Liver Cancer: Clinical Characteristics and Value in Assessing Coagulation Function | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Thromboelastographic Parameters in Patients with Primary Liver Cancer: Clinical Characteristics and Value in Assessing Coagulation Function Yanfang Wei, Zhengdeng Li, Xue Su, Sheng Zheng This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9001317/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background Patients with primary liver cancer (PLC) often present with complex coagulation disorders due to underlying liver disease. Conventional coagulation tests inadequately reflect the comprehensive hemostatic status. This study aimed to investigate the clinical characteristics of thromboelastography (TEG) parameters in PLC patients and evaluate their value in assessing coagulation function. Methods We retrospectively enrolled 1670 PLC patients who underwent surgical treatment at The Third People's Hospital of Yunnan Province between January 2020 and December 2025. Patients were stratified by cirrhosis status (non-cirrhosis, n = 348; cirrhosis, n = 1322), hepatitis B virus (HBV) infection status (HBV-infected, n = 1389; non-HBV-infected, n = 281), and liver disease severity based on Child-Pugh class, MELD score, and indocyanine green retention rate at 15 min (ICGR15). TEG parameters (R time, K time, α-angle, maximum amplitude [MA], coagulation index [CI]) and conventional coagulation tests were measured. Statistical analyses included t-tests, Mann-Whitney U tests, ANOVA, Kruskal-Wallis H tests, chi-square tests, and Spearman correlation analyses. Results Among cirrhotic patients (n = 1322), 1102 were Child-Pugh class A and 220 class B; 1084 had MELD score < 10 and 238 ≥ 10; 906 had ICGR15 < 10% and 416 ≥ 10%. Compared to Child-Pugh A patients, class B patients exhibited significantly prolonged K time, and reduced α-angle, MA, and CI (all P < 0.001). Similar trends were observed in patients with MELD score ≥ 10 versus < 10, and ICGR15 ≥ 10% versus < 10% (all P < 0.001). MA showed strong positive correlations with fibrinogen (r = 0.681, P < 0.001) and platelet count (r = 0.672, P < 0.001). MA was weakly negatively correlated with Child-Pugh score (r=-0.118, P < 0.001), MELD score (r=-0.256, P < 0.001), and ICGR15 (r=-0.121, P < 0.001). HBV-infected patients demonstrated significantly higher MA and CI compared to non-HBV-infected patients (both P < 0.05). Conclusions TEG sensitively identifies cirrhosis progression-related hypocoagulability and HBV-related hypercoagulability in PLC patients, providing valuable guidance for individualized perioperative coagulation management. Liver neoplasms Liver cirrhosis Hepatitis B virus Thromboelastography Blood coagulation Background Primary liver cancer (PLC) represents a significant global health burden, with approximately 900,000 new cases diagnosed annually worldwide [ 1 ]. In China, hepatitis B virus (HBV) infection constitutes the predominant etiology, accounting for 70–80% of all PLC cases [ 2 ]. The majority of PLC patients present with concurrent liver cirrhosis of varying severity, resulting in a uniquely complex hemostatic profile characterized by a "rebalanced" coagulation state—simultaneously exhibiting bleeding tendencies due to reduced hepatic synthesis of coagulation factors and increased thrombotic risk attributable to endothelial dysfunction, platelet hyperactivation, and impaired fibrinolytic regulation [ 3 , 4 ]. HBV infection modulates coagulation through multiple mechanisms: the viral X protein directly activates the coagulation cascade via NF-κB-mediated upregulation of tissue factor expression [ 5 ]; chronic infection induces endothelial injury with excessive von Willebrand factor (vWF) release while concurrently reducing ADAMTS13 activity, leading to accumulation of ultra-large vWF multimers that promote platelet adhesion and aggregation [ 6 , 7 ]; and the associated systemic inflammatory response triggers neutrophil extracellular trap (NET) formation, further potentiating thrombotic risk [ 8 ]. Conventional coagulation tests—including prothrombin time (PT), activated partial thromboplastin time (APTT), and international normalized ratio (INR)—primarily reflect isolated aspects of the coagulation cascade by measuring time to fibrin formation in platelet-poor plasma. These assays fail to capture crucial determinants of hemostasis such as platelet function, fibrin clot stability, and fibrinolysis, and consequently overestimate bleeding risk in cirrhotic patients [ 9 , 10 ]. Thromboelastography (TEG) is a point-of-care viscoelastic assay that dynamically monitors the entire coagulation process from initial clot formation through fibrinolysis, providing a comprehensive assessment of hemostatic function [ 11 ]. TEG parameters—reaction time (R, reflecting coagulation factor function), clot formation time (K, reflecting fibrinogen function), α-angle (reflecting clot kinetics), maximum amplitude (MA, reflecting maximal clot strength determined by platelet-fibrinogen interaction), and coagulation index (CI, overall coagulation status)—have demonstrated utility in guiding perioperative blood product administration in cirrhotic patients undergoing invasive procedures [ 12 , 13 ]. However, the characteristics of TEG parameters in HBV-related PLC patients, their relationship with liver functional reserve, and their value in discriminating between hypo- and hypercoagulable states remain inadequately characterized in large-scale studies. Therefore, this retrospective study aimed to systematically analyze TEG parameter profiles in a large cohort of PLC patients stratified by cirrhosis severity and HBV infection status, examine correlations with conventional coagulation tests and liver function scores, and evaluate the clinical utility of TEG in assessing coagulation dysfunction in this complex patient population. Methods Study design and population This retrospective cohort study consecutively enrolled patients with pathologically confirmed PLC who underwent surgical treatment at the Department of Hepatobiliary Surgery, The Third People's Hospital of Yunnan Province, between January 2020 and December 2025. Inclusion criteria: (1) age ≥18 years; (2) completion of TEG testing within one week prior to surgery; (3) complete clinical, laboratory, and pathological data. Exclusion criteria: (1) use of anticoagulant agents (warfarin, heparin, direct oral anticoagulants) or antiplatelet drugs (aspirin, clopidogrel) within two weeks prior to TEG testing; (2) blood product transfusion within one month preceding surgery; (3) preoperative imaging or intraoperative confirmation of portal vein trunk or branch tumor thrombus/thrombosis; (4) concurrent active malignancies at other sites; (5) coexisting hematological disorders, autoimmune diseases, or severe systemic infections; (6) incomplete pathological diagnosis or liver function assessment data. Grouping strategies Patients were stratified based on histopathological examination: non-cirrhosis group (absence of cirrhosis) and cirrhosis group (presence of cirrhosis). The cirrhosis group was further categorized according to: Child-Pugh class (A vs. B) Model for End-Stage Liver Disease (MELD) score (<10 vs. ≥10) Indocyanine green retention rate at 15 minutes (ICGR15; <10% vs. ≥10%) Based on HBV infection status, patients were divided into HBV-infected and non-HBV-infected groups. HBV infection was defined as positive hepatitis B surface antigen (HBsAg) for ≥6 months. Data collection Demographic and clinical characteristics: age, sex, etiology (HBV, HCV, alcohol-related, other), tumor type (hepatocellular carcinoma, cholangiocarcinoma, mixed), tumor diameter, tumor number (solitary vs. multiple). Laboratory parameters: conventional coagulation tests—prothrombin time (PT), activated partial thromboplastin time (APTT), international normalized ratio (INR), fibrinogen (FIB), D-dimer; platelet count (PLT); liver function tests—alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil), albumin (ALB). Thromboelastography: TEG 5000 or TEG 6s thromboelastography analyzers (Haemonetics Corp., Braintree, MA, USA) were used according to standardized protocols [14]. Parameters recorded included: R time (minutes): latency time from test initiation until initial fibrin formation (amplitude reaching 2 mm); reflects coagulation factor function K time (minutes): time from R time endpoint to amplitude reaching 20 mm; reflects fibrinogen function and initial clot formation kinetics α-angle (degrees): slope between R and K times; represents rate of fibrin cross-linking and clot strengthening MA (mm): maximum amplitude; reflects maximal clot strength determined by platelet function and fibrinogen concentration CI: calculated composite index reflecting overall coagulation status (normal range: -3.0 to +3.0) Liver functional reserve: ICGR15 measured by pulse spectrophotometry using a DDG-3300K analyzer (Nihon Kohden, Tokyo, Japan). Pathological findings: cirrhosis presence/absence, tumor differentiation grade, microvascular invasion status. Statistical analysis Statistical analyses were performed using SPSS version 27.0 (IBM Corp., Armonk, NY, USA). Normality of continuous variables was assessed using the Shapiro-Wilk test and visual inspection of Q-Q plots. Continuous variables: Normally distributed data were expressed as mean ± standard deviation (SD); comparisons between two groups employed independent samples t-test, and among multiple groups used one-way analysis of variance (ANOVA) with least significant difference (LSD) post-hoc test for pairwise comparisons. Non-normally distributed data were expressed as median with interquartile range [M (P25–P75)]; comparisons between two groups used Mann-Whitney U test, and among multiple groups used Kruskal-Wallis H test with Bonferroni correction for pairwise comparisons. Categorical variables: Presented as frequencies and percentages (n, %); comparisons between groups used chi-square test or Fisher's exact probability test as appropriate. Correlation analyses: Spearman's rank correlation coefficient was calculated to assess relationships between TEG parameters and conventional coagulation tests or liver function scores. Correlation strength was interpreted as: |r|<0.3, weak; 0.3≤|r|<0.6, moderate; |r|≥0.6, strong. All statistical tests were two-sided, and P-values <0.05 were considered statistically significant. Ethical considerations This study was approved by the Ethics Committee of The Third People's Hospital of Yunnan Province. Given the retrospective design utilizing de-identified data with no direct patient contact or interventions, the requirement for informed consent was waived by the ethics committee. All procedures complied with the ethical standards of the institutional research committee and the 1964 Helsinki Declaration and its later amendments. Results Baseline characteristics A total of 1670 PLC patients were included in the final analysis, comprising 348 (20.8%) non-cirrhotic and 1322 (79.2%) cirrhotic patients. Among cirrhotic patients, 1102 (83.4%) were Child-Pugh class A and 220 (16.6%) class B; 1084 (82.0%) had MELD score < 10 and 238 (18.0%) ≥ 10; 906 (68.5%) had ICGR15 < 10% and 416 (31.5%) ≥ 10%. HBV infection was present in 1389 patients (83.2%), confirming HBV as the predominant etiological factor in this cohort. Table 1 presents baseline characteristics stratified by cirrhosis status. Compared to non-cirrhotic patients, cirrhotic patients had significantly higher proportions of males (81.4% vs. 73.0%, P = 0.002), hepatocellular carcinoma (97.3% vs. 72.7%, P < 0.001), and HBV infection (85.4% vs. 74.7%, P < 0.001). Tumor diameter was smaller in cirrhotic patients (5.38 ± 3.42 cm vs. 6.93 ± 3.87 cm, P < 0.001). Cirrhotic patients exhibited significantly higher AST (P = 0.002) and total bilirubin (P < 0.001) levels, while albumin levels showed no significant intergroup difference (P = 0.058). Table 1 Baseline characteristics of study patients stratified by cirrhosis status Characteristic Non-cirrhosis (n = 348) Cirrhosis (n = 1322) Statistic P-value Age (years), mean ± SD 55.83 ± 11.76 54.62 ± 10.38 t = 1.892 0.059 Sex, n (%) χ²=9.634 0.002 Male 254 (73.0) 1076 (81.4) Female 94 (27.0) 246 (18.6) Etiology, n (%) χ²=28.762 < 0.001 HBV 260 (74.7) 1129 (85.4) HCV 11 (3.2) 84 (6.4) HBV + HCV 4 (1.1) 51 (3.9) Other 73 (21.0) 58 (4.4) Tumor type, n (%) χ²=186.534 < 0.001 Hepatocellular carcinoma 253 (72.7) 1286 (97.3) Cholangiocarcinoma 95 (27.3) 36 (2.7) Tumor diameter (cm), mean ± SD 6.93 ± 3.87 5.38 ± 3.42 t = 7.153 < 0.001 Tumor number, n (%) χ²=12.845 0.093 Solitary 258 (74.1) 862 (65.2) Multiple (≥ 2) 90 (25.9) 460 (34.8) ALT (U/L), M (P25–P75) 27.5 (17.5–44.5) 28.5 (19.5–47.5) Z=−0.726 0.468 AST (U/L), M (P25–P75) 28.5 (20.5–45.5) 31.5 (23.5–50.5) Z=−3.126 0.002 Total bilirubin (µmol/L), M (P25–P75) 11.8 (9.0–16.9) 13.5 (9.9–21.2) Z=−4.238 < 0.001 Albumin (g/L), mean ± SD 37.62 ± 4.85 37.08 ± 4.73 t = 1.894 0.058 Abbreviations: HBV, hepatitis B virus; HCV, hepatitis C virus; ALT, alanine aminotransferase; AST, aspartate aminotransferase; SD, standard deviation. TEG parameters according to liver disease severity TEG parameters demonstrated progressive hypocoagulable alterations with increasing liver disease severity (Tables 2 , 3 , and 4 ). Table 2 TEG parameters stratified by Child-Pugh class TEG parameter Non-cirrhosis (n = 348) Cirrhosis group Statistic P-value Child-Pugh A (n = 1102) Child-Pugh B (n = 220) R time (min), mean ± SD 5.63 ± 1.08 5.85 ± 1.29 5.69 ± 1.13 F = 3.142 0.043 K time (min), M (P25–P75) 1.7 (1.4–2.2) 2.3 (1.8–2.8)¹ 2.6 (2.1–3.3)¹,² H = 96.847 < 0.001 α-angle (°), mean ± SD 65.43 ± 7.28 60.18 ± 10.72¹ 58.92 ± 10.46¹,² F = 29.634 < 0.001 MA (mm), mean ± SD 61.87 ± 7.25 55.28 ± 7.48¹ 52.86 ± 10.63¹,² F = 82.156 < 0.001 CI, M (P25–P75) 0.4 (−0.8–1.6) −1.1 (−2.4–0.2)¹ −1.5 (−3.3–0.4)¹,² H = 103.528 < 0.001 Abbreviations: TEG, thromboelastography; R time, reaction time; K time, clot formation time; α-angle, coagulation angle; MA, maximum amplitude; CI, coagulation index; SD, standard deviation. ¹ P < 0.05 vs. non-cirrhosis group; ² P < 0.05 vs. Child-Pugh A group. Table 3 TEG parameters stratified by MELD score TEG parameter Non-cirrhosis (n = 348) Cirrhosis group Statistic P-value MELD < 10 (n = 1084) MELD ≥ 10 (n = 238) R time (min), mean ± SD 5.63 ± 1.08 5.82 ± 1.28 5.84 ± 1.27 F = 2.184 0.113 K time (min), M (P25–P75) 1.7 (1.4–2.2) 2.3 (1.8–2.8)¹ 2.9 (2.2–3.8)¹,² H = 136.852 < 0.001 α-angle (°), mean ± SD 65.43 ± 7.28 60.58 ± 10.64¹ 56.43 ± 10.32¹,² F = 42.386 < 0.001 MA (mm), mean ± SD 61.87 ± 7.25 55.83 ± 7.46¹ 50.62 ± 9.68¹,² F = 112.634 < 0.001 CI, M (P25–P75) 0.4 (−0.8–1.6) −1.0 (−2.3–0.3)¹ −2.2 (−3.9–−0.6)¹,² H = 128.754 < 0.001 Abbreviations: MELD, Model for End-Stage Liver Disease; TEG, thromboelastography. ¹ P < 0.05 vs. non-cirrhosis group; ² P < 0.05 vs. MELD < 10 group. Table 4 TEG parameters stratified by ICGR15 levels in cirrhotic patients TEG parameter ICGR15 < 10% (n = 906) ICGR15 ≥ 10% (n = 416) Statistic P-value R time (min), mean ± SD 5.88 ± 1.27 5.70 ± 1.28 t = 2.386 0.017 K time (min), M (P25–P75) 2.38 (1.79–2.79) 2.83 (2.01–3.52) Z=−5.634 < 0.001 α-angle (°), mean ± SD 60.43 ± 11.08 58.72 ± 9.96 t = 2.418 0.016 MA (mm), mean ± SD 55.86 ± 7.24 52.63 ± 9.63 t = 5.372 < 0.001 CI, mean ± SD −1.09 ± 2.18 −1.58 ± 2.79 t = 2.385 0.017 Abbreviations: ICGR15, indocyanine green retention rate at 15 minutes; TEG, thromboelastography. Child-Pugh classification: Compared to Child-Pugh A patients, Child-Pugh B patients exhibited significantly prolonged K time [2.6 (2.1–3.3) vs. 2.3 (1.8–2.8) min, P < 0.001] and reduced α-angle (58.92 ± 10.46 vs. 60.18 ± 10.72°, P < 0.001), MA (52.86 ± 10.63 vs. 55.28 ± 7.48 mm, P < 0.001), and CI [-1.5 (-3.3–0.4) vs. -1.1 (-2.4–0.2), P < 0.001] (Table 2 ). MELD score: Patients with MELD score ≥ 10 showed significantly prolonged K time [2.9 (2.2–3.8) vs. 2.3 (1.8–2.8) min, P < 0.001] and reduced α-angle (56.43 ± 10.32 vs. 60.58 ± 10.64°, P < 0.001), MA (50.62 ± 9.68 vs. 55.83 ± 7.46 mm, P < 0.001), and CI [-2.2 (-3.9– -0.6) vs. -1.0 (-2.3–0.3), P < 0.001] compared to those with MELD score < 10 (Table 3 ). ICGR15: Patients with ICGR15 ≥ 10% demonstrated significantly prolonged K time [2.83 (2.01–3.52) vs. 2.38 (1.79–2.79) min, P < 0.001], reduced MA (52.63 ± 9.63 vs. 55.86 ± 7.24 mm, P < 0.001), and modest but significant reductions in R time (5.70 ± 1.28 vs. 5.88 ± 1.27 min, P = 0.017), α-angle (58.72 ± 9.96 vs. 60.43 ± 11.08°, P = 0.016), and CI (-1.58 ± 2.79 vs. -1.09 ± 2.18, P = 0.017) compared to those with ICGR15 < 10% (Table 4 ). Correlations between TEG parameters and conventional coagulation tests In the overall cohort (n = 1670), MA demonstrated strong positive correlations with fibrinogen (r = 0.681, P < 0.001) and platelet count (r = 0.672, P < 0.001), confirming MA as a reliable integrative indicator of platelet-fibrinogen interaction (Table 5 ). K time showed moderate-to-strong negative correlations with fibrinogen (r=-0.614, P < 0.001) and platelet count (r=-0.556, P < 0.001), while α-angle exhibited moderate positive correlations with these parameters (r = 0.583 and 0.518, respectively, both P < 0.001). CI correlated significantly with all conventional coagulation parameters, most strongly with fibrinogen (r = 0.592, P < 0.001) and platelet count (r = 0.558, P < 0.001). All TEG parameters showed significant but weak-to-moderate correlations with PT, INR, and D-dimer (all P < 0.001). Table 5 Spearman correlations between TEG parameters and conventional coagulation tests (overall population, n = 1670) TEG parameter PT INR FIB D-dimer PLT r P r P r P r P r P R time −0.009 0.712 −0.021 0.386 −0.094 0.001 −0.192 < 0.001 −0.108 < 0.001 K time 0.218 < 0.001 0.252 < 0.001 −0.614 < 0.001 −0.273 < 0.001 −0.556 < 0.001 α-angle −0.184 < 0.001 −0.216 < 0.001 0.583 < 0.001 0.294 < 0.001 0.518 < 0.001 MA −0.273 < 0.001 −0.312 < 0.001 0.681 < 0.001 0.289 < 0.001 0.672 < 0.001 CI −0.202 < 0.001 −0.234 < 0.001 0.592 < 0.001 0.311 < 0.001 0.558 < 0.001 Abbreviations: PT, prothrombin time; INR, international normalized ratio; FIB, fibrinogen; PLT, platelet count; TEG, thromboelastography. Correlations between TEG parameters and liver function scores MA showed weak but statistically significant negative correlations with Child-Pugh score (r=-0.118, P < 0.001), MELD score (r=-0.256, P < 0.001), and ICGR15 (r=-0.121, P < 0.001), indicating progressive reduction in maximal clot strength with deteriorating liver function (Table 6 ). K time, α-angle, and CI were weakly correlated with MELD score (r = 0.228, -0.191, and − 0.188, respectively; all P < 0.001). R time demonstrated a weak negative correlation with ICGR15 (r=-0.085, P = 0.003). Table 6 Spearman correlations between TEG parameters and liver function scores (overall population, n = 1670) TEG parameter Child-Pugh score MELD score ICGR15 r P r P r P R time −0.016 0.512 −0.048 0.086 −0.085 0.003 K time 0.062 0.054 0.228 < 0.001 0.058 0.062 α-angle −0.031 0.352 −0.191 < 0.001 −0.022 0.468 MA −0.118 < 0.001 −0.256 < 0.001 −0.121 < 0.001 CI −0.064 0.052 −0.188 < 0.001 −0.052 0.096 Abbreviations: Child-Pugh score, Child-Turcotte-Pugh score; MELD, Model for End-Stage Liver Disease; ICGR15, indocyanine green retention rate at 15 minutes; TEG, thromboelastography. Impact of HBV infection on TEG parameters HBV-infected patients (n = 1389) exhibited significantly higher MA (56.3 ± 7.7 vs. 52.9 ± 8.3 mm, P = 0.008) and CI (-1.15 ± 2.48 vs. -1.68 ± 2.82, P = 0.015) compared to non-HBV-infected patients (n = 281), indicating a relatively hypercoagulable state associated with HBV infection (Table 7 ). No significant differences were observed in R time, K time, or α-angle between groups. Table 7 Comparison of TEG parameters between HBV-infected and non-HBV-infected patients TEG parameter HBV-infected (n = 1389) Non-HBV-infected (n = 281) t-value P-value R time (min), mean ± SD 5.82 ± 1.27 5.78 ± 1.25 0.483 0.629 K time (min), mean ± SD 2.47 ± 1.18 2.53 ± 1.14 −0.786 0.432 α-angle (°), mean ± SD 60.43 ± 10.58 59.82 ± 10.86 0.864 0.388 MA (mm), mean ± SD 56.3 ± 7.7 52.9 ± 8.3 5.684 0.008 CI, mean ± SD −1.15 ± 2.48 −1.68 ± 2.82 −1.68 ± 2.82 0.015 Abbreviations: HBV, hepatitis B virus; TEG, thromboelastography; MA, maximum amplitude; CI, coagulation index; SD, standard deviation. Discussion This large retrospective cohort study systematically characterized TEG parameters in 1670 PLC patients stratified by cirrhosis severity and HBV infection status, demonstrating that TEG sensitively detects both hypocoagulable alterations associated with progressive liver dysfunction and hypercoagulable tendencies specifically related to HBV infection. These findings extend current understanding of coagulation dysfunction in PLC and support the clinical utility of TEG for individualized perioperative coagulation management. TEG parameters reflect cirrhosis progression-related hypocoagulability Our results demonstrate progressive hypocoagulable alterations in TEG parameters with increasing liver disease severity. Patients with advanced cirrhosis (Child-Pugh B, MELD ≥10, or ICGR15 ≥10%) exhibited significantly prolonged K time and reduced α-angle, MA, and CI compared to those with compensated cirrhosis. These findings align with the conceptual framework of "rebalanced hemostasis" in liver disease, wherein parallel reductions in procoagulant and anticoagulant factors maintain hemostatic equilibrium in compensated cirrhosis, but progressive hepatic synthetic dysfunction ultimately disrupts this balance, leading to net hypocoagulability [4, 15]. Notably, patients with MELD score ≥10 demonstrated mean MA of 50.62±9.68 mm, falling below the clinically relevant threshold of 55 mm proposed by de Pietri et al. [12] for guiding prophylactic intervention before invasive procedures. This observation suggests that MELD score ≥10 identifies a high-risk subgroup warranting comprehensive hemostatic assessment and potential preemptive measures to mitigate bleeding complications during surgical interventions. The strong correlations between MA and both fibrinogen (r=0.681) and platelet count (r=0.672) corroborate MA as an integrative parameter reflecting platelet-fibrinogen interaction and clot strength. Fibrinogen, synthesized exclusively by hepatocytes, and platelets, which may be reduced due to hypersplenism and impaired thrombopoietin production in cirrhosis, constitute critical determinants of hemostatic competence [16, 17]. Our findings support the concept that adequate fibrinogen levels and platelet function are essential for maintaining clot integrity in cirrhotic patients, and that MA provides clinically relevant information beyond isolated measurement of these components [18]. The significant associations between TEG parameters and ICGR15—a quantitative measure of hepatic functional reserve—extend previous observations by demonstrating that TEG abnormalities correlate not only with static disease severity scores but also with dynamic liver function capacity. This finding suggests potential utility of TEG in preoperative risk stratification, complementing established metrics such as Child-Pugh and MELD scores. HBV infection confers a hypercoagulable tendency The most striking finding of this study is the significantly higher MA and CI observed in HBV-infected compared to non-HBV-infected PLC patients, indicating a relative hypercoagulable state associated with chronic HBV infection. This observation has important clinical implications given that HBV accounts for approximately 80% of PLC cases in China and other endemic regions. The hypercoagulability in HBV-related PLC likely reflects multifactorial mechanisms [19-21]: Direct viral effects: HBV X protein (HBx) transactivates tissue factor gene expression via NF-κB and AP-1 signaling pathways, promoting extrinsic pathway activation [5, 22]. HBx also upregulates plasminogen activator inhibitor-1 (PAI-1), impairing fibrinolytic capacity [23]. Endothelial dysfunction: Chronic HBV infection induces systemic inflammation and endothelial injury, resulting in excessive vWF release from Weibel-Palade bodies. Concurrently, HBV suppresses ADAMTS13 synthesis and activity, leading to accumulation of ultra-large vWF multimers that promote platelet adhesion and aggregation under shear stress [6, 24]. Platelet hyperreactivity: HBV antigens directly interact with platelet surface receptors, inducing activation and degranulation. Elevated levels of soluble P-selectin and platelet-derived microparticles have been documented in chronic hepatitis B patients, correlating with disease activity [25]. Procoagulant microparticles: HBV infection increases circulating tissue factor-bearing microparticles derived from activated platelets, endothelial cells, and monocytes, providing an additional procoagulant surface for thrombin generation [26]. Inflammation-coagulation crosstalk: The chronic inflammatory state characteristic of HBV infection upregulates proinflammatory cytokines (IL-6, TNF-α) that simultaneously enhance coagulation through tissue factor induction and impair anticoagulant pathways [27]. The clinical relevance of HBV-associated hypercoagulability warrants emphasis. Patients with HBV-related PLC and elevated MA (particularly >65 mm) may face increased risk of portal vein thrombosis (PVT), a complication occurring in 10–40% of HCC patients with significantly worse prognosis [28, 29]. PVT can compromise portal flow, exacerbate portal hypertension, limit treatment options, and directly impact survival. Therefore, heightened vigilance for thrombotic complications and consideration of thromboprophylaxis strategies may be appropriate in selected high-risk HBV-related PLC patients, particularly those with additional prothrombotic risk factors such as advanced age, immobilization, or active systemic therapy [30]. Comparative value of TEG versus conventional coagulation tests Our correlation analyses demonstrated significant associations between TEG parameters and conventional coagulation tests, yet the modest correlation coefficients (generally r<0.6 for most comparisons except MA with fibrinogen/platelets) highlight the complementary rather than interchangeable nature of these assays. TEG offers distinct advantages by providing a global assessment of hemostasis that integrates plasma coagulation, platelet function, and clot stability under conditions approximating whole blood physiology [11, 31]. Several studies have documented substantial discrepancies between TEG and conventional coagulation tests in cirrhotic patients. Ambulkar et al. [32] prospectively evaluated 68 patients undergoing major liver resection and found that 56% of patients with prolonged INR had normal TEG parameters; reliance on INR would have prompted unnecessary blood product administration. Similarly, Gaspari et al. [33] using the newer generation TEG 6s device reported that only 10.5% of patients with abnormal conventional coagulation tests demonstrated corresponding TEG abnormalities, and TEG-defined coagulopathy correlated better with actual perioperative bleeding than conventional parameters. The implications for clinical practice are substantial. Indiscriminate correction of abnormal PT/INR in cirrhotic patients frequently results in unnecessary transfusion, exposing patients to risks of volume overload, transfusion reactions, and immunomodulation without proven hemostatic benefit [34, 35]. Conversely, conventional tests fail to identify the hypercoagulable phenotype associated with HBV infection, potentially missing opportunities for thromboprophylaxis. TEG-based algorithms have demonstrated efficacy in reducing blood product utilization during liver transplantation and other invasive procedures in cirrhotic patients without increasing bleeding complications [12, 36]. Clinical implications and proposed management algorithm Based on our findings integrated with current evidence, we propose the following risk-stratified approach to perioperative coagulation management in PLC patients: Preoperative risk stratification: All PLC patients with cirrhosis should undergo baseline TEG assessment. Those with Child-Pugh class B/C, MELD score ≥10, or ICGR15 ≥10% represent high-risk populations for hypocoagulability warranting particular attention. Transfusion triggers: Based on established thresholds [12, 37], consider prophylactic intervention when: MA <55 mm: evaluate for platelet transfusion or desmopressin (if platelet dysfunction suspected) K time prolonged with reduced α-angle and fibrinogen <150–200 mg/dL: consider cryoprecipitate or fibrinogen concentrate R time prolonged with elevated INR: consider fresh frozen plasma or prothrombin complex concentrate, though isolated R time prolongation without other abnormalities may not require correction Thrombosis surveillance: For HBV-related PLC patients with MA >65 mm and/or CI >+3.0, consider: Preoperative Doppler ultrasound screening for PVT Enhanced postoperative thrombosis surveillance, particularly if additional risk factors present Individualized assessment of thromboprophylaxis risk-benefit, weighing thrombotic risk against bleeding propensity Postoperative monitoring: Patients with impaired hepatic reserve (ICGR15 ≥10%) should undergo serial TEG monitoring postoperatively, as liver dysfunction may worsen following resection, exacerbating coagulation abnormalities. This algorithm aligns with evolving international guidelines. The 2023 European Association for the Study of the Liver (EASL) clinical practice guidelines on coagulation in cirrhosis emphasize the value of viscoelastic testing for guiding hemostatic interventions and recommend against routine correction of coagulation parameters based solely on conventional tests [38]. Similarly, the 2024 Chinese guidelines on hepatocellular carcinoma management highlight the importance of comprehensive coagulation assessment in treatment planning [39]. Study strengths and limitations This study has several strengths, including the large sample size (n=1670) enabling robust subgroup analyses, comprehensive characterization of both cirrhosis severity and HBV infection status, and systematic evaluation of correlations between TEG parameters and multiple clinically relevant indices. The inclusion of ICGR15 as a quantitative measure of hepatic functional reserve extends previous observations linking TEG abnormalities to liver dysfunction. Several limitations warrant consideration. First, the retrospective single-center design introduces potential selection bias and limits causal inference. The observed associations between TEG parameters and clinical characteristics cannot establish predictive value for patient-important outcomes such as bleeding events, thrombotic complications, or mortality. Second, we lacked longitudinal follow-up data to assess relationships between TEG parameters and long-term clinical outcomes. Third, the study period spanned five years during which surgical techniques and perioperative management may have evolved, potentially introducing temporal bias. Fourth, while we identified significant differences between HBV-infected and non-HBV-infected patients, the non-HBV group was heterogeneous, comprising patients with HCV infection, alcohol-related liver disease, and other etiologies, limiting specific comparisons. Fifth, we did not perform multivariable regression analyses to adjust for potential confounders such as tumor stage, portal hypertension severity, or concurrent medications. Finally, the proposed management algorithm requires prospective validation to establish its impact on clinical outcomes and cost-effectiveness. Future multicenter prospective studies should evaluate whether TEG-guided management strategies reduce bleeding complications, thrombotic events, and unnecessary transfusions in PLC patients undergoing surgical intervention, and whether integration of TEG parameters with established prognostic scores improves risk prediction and guides individualized therapy. Conclusions Thromboelastography sensitively identifies cirrhosis progression-related hypocoagulability and HBV infection-related hypercoagulability in patients with primary liver cancer. TEG parameters, particularly maximum amplitude, demonstrate strong correlations with fibrinogen and platelet count while providing integrated assessment of global hemostatic function beyond conventional coagulation tests. These findings support the incorporation of TEG into routine perioperative coagulation assessment for PLC patients, enabling individualized risk stratification and targeted management of both bleeding and thrombotic complications. Abbreviations PLC Primary liver cancer TEG Thromboelastography HBV Hepatitis B virus MELD Model for End-Stage Liver Disease ICGR15 Indocyanine green retention rate at 15 minutes PT Prothrombin time INR International normalized ratio APTT Activated partial thromboplastin time FIB Fibrinogen PLT Platelet count MA Maximum amplitude CI Coagulation index R time Reaction time K time Clot formation time vWF von Willebrand factor PVT Portal vein thrombosis SD Standard deviation IQR Interquartile range. Declarations Acknowledgements Not applicable. Authors' contributions YFW and ZDL contributed equally to this work. YFW, XS, ZDL, and SZ made substantial contributions to the conception and design of the study, critical manuscript review and revisions, and study interpretation. YFW, ZDL, and SZ performed data acquisition, analysis, and interpretation, as well as technical and material support. YFW and XS drafted the initial manuscript. All authors read and approved the final manuscript. The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Funding This work was supported by the Yunnan Health Training Project of High-Level Talents (Grant No. D-2024049) and the Yunnan Province High-Level Scientific and Technological Talents and Innovation Team Selection Special—Young and Middle-Aged Academic and Technical Leaders Reserve Talent Project (Grant No. 202405AC350067). The funding bodies played no role in the design of the study, collection, analysis, and interpretation of data, or in writing the manuscript. Availability of data and materials The data generated and analyzed during this study are not publicly available due to the inclusion of information that could compromise the privacy of research participants but are available from the corresponding author upon reasonable request. Ethics approval and consent to participate This study was approved by the Ethics Committee of The Third People's Hospital of Yunnan Province (Approval No.: YNSY-EC-2025-068). Due to the retrospective nature of the study utilizing de-identified patient data from medical records, the requirement for informed consent was waived by the ethics committee. This waiver is in accordance with the Chinese national regulations for ethical review of biomedical research involving humans (Article 39 of the ‘Measures for the Ethical Review of Biomedical Research Involving Humans’). All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. References Sung H, Ferlay J, Siegel RL, et al. 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Cancers (Basel). 2025;17(21):3413. DOI: 10.3390/cancers17213413 Kluź N, Lamparello R, Kozłowska M, et al. Platelets in hepatocellular carcinoma—from pathogenesis to targeted therapy. Cancers (Basel). 2025;17(14):2391. DOI: 10.3390/cancers17142391 Weisel JW, Litvinov RI. Fibrin formation, structure and properties. Subcell Biochem. 2017;82:405-456. DOI: 10.1007/978-3-319-49674-0_13 Zhou Y, Wang S, Ma JW, et al. Hepatitis B virus protein X-induced expression of the C-type lectin CD91 inhibits hepatocellular carcinoma cell apoptosis. Mol Med Rep. 2014;10(4):1739-1744. DOI: 10.3892/mmr.2014.2429 Tanaka Y, Kanai F, Kawakami T, et al. Interaction of the hepatitis B virus X protein (HBx) with heat shock protein 60 enhances HBx-mediated apoptosis. Biochem Biophys Res Commun. 2004;318(2):461-469. DOI: 10.1016/j.bbrc.2004.04.046 Uemura M, Fujimura Y, Matsumoto M, et al. Comprehensive analysis of ADAMTS13 in patients with liver cirrhosis. Thromb Haemost. 2008;99(6):1019-1029. 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Effect of everolimus on survival in advanced hepatocellular carcinoma after failure of sorafenib: the EVOLVE-1 randomized clinical trial. JAMA. 2014;312(1):57-67. DOI: 10.1001/jama.2014.7189 Goyal S, Jadaun S, Kedia S, et al. Thromboelastography parameters in patients with acute on chronic liver failure. Ann Hepatol. 2018;17(6):1042-1051. DOI: 10.5604/01.3001.0012.7205 Ambulkar R, Silva W, Shetty G, et al. Evaluation of perioperative routine coagulation testing versus thromboelastography for major liver resection - A single-arm, prospective, interventional trial (PORTAL trial). Indian J Anaesth. 2023;67(12):1077-1083. DOI: 10.4103/ija.ija_344_23 Gaspari R, Aceto P, Carelli S, et al. Discrepancy between conventional coagulation tests and thromboelastography during the early postoperative phase of liver resection in neoplastic patients: a prospective study using the new-generation TEG®6s. J Clin Med. 2025;14(9):2866. DOI: 10.3390/jcm14092866 Mpaili E, Tsakanatos K, Karamagiolis S, et al. Utility of viscoelastic coagulation testing in liver surgery: a systematic review. HPB (Oxford). 2021;23(3):331-343. DOI: 10.1016/j.hpb.2020.10.023 Kozek-Langenecker SA, Afshari A, Albaladejo P, et al. Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol. 2013;30(6):270-382. DOI: 10.1097/EJA.0b013e32835f4d5b Liu B, Zhang Q, Zhang J. Guiding role of thromboelastography in clinical blood transfusion in patients with coagulation dysfunction after liver cancer surgery and its effect on coagulation indexes and blood coagulation quality. J Clin Exp Med. 2025;24(7):754-758. DOI: 10.3969/j.issn.1671-4695.2025.07.021 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. Exp Ther Med. 2020;20(3):2657-2664. DOI: 10.3892/etm.2020.8990 European Association for the Study of the Liver. EASL Clinical Practice Guidelines on prevention and management of bleeding and thrombosis in patients with cirrhosis. J Hepatol. 2022;76(5):1151-1184. DOI: 10.1016/j.jhep.2021.09.003 Xie DY, Zhu K, Ren ZG, et al. A review of 2022 Chinese clinical guidelines on the management of hepatocellular carcinoma: updates and insights. Hepatobiliary Surg Nutr. 2023;12(2):216-228. DOI: 10.21037/hbsn-22-469 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9001317","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":611942146,"identity":"98d11940-d1a5-4b1f-8690-1bcdfdd7045d","order_by":0,"name":"Yanfang Wei","email":"","orcid":"","institution":"Dali University","correspondingAuthor":false,"prefix":"","firstName":"Yanfang","middleName":"","lastName":"Wei","suffix":""},{"id":611942147,"identity":"b08e8dff-cebb-46f7-8783-ecd2724b8b1c","order_by":1,"name":"Zhengdeng Li","email":"","orcid":"","institution":"Dali University","correspondingAuthor":false,"prefix":"","firstName":"Zhengdeng","middleName":"","lastName":"Li","suffix":""},{"id":611942148,"identity":"84a99252-deb8-4133-8707-88a0d0031bcf","order_by":2,"name":"Xue Su","email":"","orcid":"","institution":"Dali University","correspondingAuthor":false,"prefix":"","firstName":"Xue","middleName":"","lastName":"Su","suffix":""},{"id":611942149,"identity":"178dc1b1-1453-4bf6-9802-ccf46791f4ec","order_by":3,"name":"Sheng Zheng","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBUlEQVRIiWNgGAWjYDACCQiVAMTsHz78sGFgI0ULG+PMnjQStTDzsB0m7C752c3HHn5hqMvjl26/9oCH57w9n3TzA4YfFdtwamGccyzdWIbhcLHknDPlBhIWtxPbZI4ZMPacuY1TC7NEjpm0BMOBxA03chIkDHhuJ7BJJBgwM7bh1sImkf8NqKUucT9ISwLbOXs2ifQPeLXwSOSwSX5gYE7cIJF+TOIA2wHGNokc/LZISKSZSTMwHE6ccSOH2bCxJzkRqKXgID6/yM9Ifib5A+iw/hnpDx//+WFnLz8jfeODHxW4tYCDgPcf2I0GcJEDeNUDAeMPMMX+gJDCUTAKRsEoGKEAAI7MVF0JH2U5AAAAAElFTkSuQmCC","orcid":"","institution":"The Third People's Hospital of Yunnan Province","correspondingAuthor":true,"prefix":"","firstName":"Sheng","middleName":"","lastName":"Zheng","suffix":""}],"badges":[],"createdAt":"2026-03-01 12:08:33","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9001317/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9001317/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":105550947,"identity":"1669102b-531d-4ae2-88d0-894111718467","added_by":"auto","created_at":"2026-03-27 09:57:50","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1165271,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9001317/v1/0a182fb8-0d02-4c8e-b25a-6ded5d7f2d3a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Thromboelastographic Parameters in Patients with Primary Liver Cancer: Clinical Characteristics and Value in Assessing Coagulation Function","fulltext":[{"header":"Background","content":"\u003cp\u003ePrimary liver cancer (PLC) represents a significant global health burden, with approximately 900,000 new cases diagnosed annually worldwide [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In China, hepatitis B virus (HBV) infection constitutes the predominant etiology, accounting for 70\u0026ndash;80% of all PLC cases [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The majority of PLC patients present with concurrent liver cirrhosis of varying severity, resulting in a uniquely complex hemostatic profile characterized by a \"rebalanced\" coagulation state\u0026mdash;simultaneously exhibiting bleeding tendencies due to reduced hepatic synthesis of coagulation factors and increased thrombotic risk attributable to endothelial dysfunction, platelet hyperactivation, and impaired fibrinolytic regulation [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHBV infection modulates coagulation through multiple mechanisms: the viral X protein directly activates the coagulation cascade via NF-κB-mediated upregulation of tissue factor expression [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]; chronic infection induces endothelial injury with excessive von Willebrand factor (vWF) release while concurrently reducing ADAMTS13 activity, leading to accumulation of ultra-large vWF multimers that promote platelet adhesion and aggregation [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]; and the associated systemic inflammatory response triggers neutrophil extracellular trap (NET) formation, further potentiating thrombotic risk [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eConventional coagulation tests\u0026mdash;including prothrombin time (PT), activated partial thromboplastin time (APTT), and international normalized ratio (INR)\u0026mdash;primarily reflect isolated aspects of the coagulation cascade by measuring time to fibrin formation in platelet-poor plasma. These assays fail to capture crucial determinants of hemostasis such as platelet function, fibrin clot stability, and fibrinolysis, and consequently overestimate bleeding risk in cirrhotic patients [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThromboelastography (TEG) is a point-of-care viscoelastic assay that dynamically monitors the entire coagulation process from initial clot formation through fibrinolysis, providing a comprehensive assessment of hemostatic function [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. TEG parameters\u0026mdash;reaction time (R, reflecting coagulation factor function), clot formation time (K, reflecting fibrinogen function), α-angle (reflecting clot kinetics), maximum amplitude (MA, reflecting maximal clot strength determined by platelet-fibrinogen interaction), and coagulation index (CI, overall coagulation status)\u0026mdash;have demonstrated utility in guiding perioperative blood product administration in cirrhotic patients undergoing invasive procedures [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, the characteristics of TEG parameters in HBV-related PLC patients, their relationship with liver functional reserve, and their value in discriminating between hypo- and hypercoagulable states remain inadequately characterized in large-scale studies. Therefore, this retrospective study aimed to systematically analyze TEG parameter profiles in a large cohort of PLC patients stratified by cirrhosis severity and HBV infection status, examine correlations with conventional coagulation tests and liver function scores, and evaluate the clinical utility of TEG in assessing coagulation dysfunction in this complex patient population.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design and population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis retrospective cohort study consecutively enrolled patients with pathologically confirmed PLC who underwent surgical treatment at the Department of Hepatobiliary Surgery, The Third People's Hospital of Yunnan Province, between January 2020 and December 2025.\u003c/p\u003e\n\u003cp\u003eInclusion criteria: (1) age ≥18 years; (2) completion of TEG testing within one week prior to surgery; (3) complete clinical, laboratory, and pathological data.\u003c/p\u003e\n\u003cp\u003eExclusion criteria: (1) use of anticoagulant agents (warfarin, heparin, direct oral anticoagulants) or antiplatelet drugs (aspirin, clopidogrel) within two weeks prior to TEG testing; (2) blood product transfusion within one month preceding surgery; (3) preoperative imaging or intraoperative confirmation of portal vein trunk or branch tumor thrombus/thrombosis; (4) concurrent active malignancies at other sites; (5) coexisting hematological disorders, autoimmune diseases, or severe systemic infections; (6) incomplete pathological diagnosis or liver function assessment data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGrouping strategies\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients were stratified based on histopathological examination: non-cirrhosis group (absence of cirrhosis) and cirrhosis group (presence of cirrhosis). The cirrhosis group was further categorized according to:\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Child-Pugh class (A vs. B)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Model for End-Stage Liver Disease (MELD) score (\u0026lt;10 vs. ≥10)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Indocyanine green retention rate at 15 minutes (ICGR15; \u0026lt;10% vs. ≥10%)\u003c/p\u003e\n\u003cp\u003eBased on HBV infection status, patients were divided into HBV-infected and non-HBV-infected groups. HBV infection was defined as positive hepatitis B surface antigen (HBsAg) for ≥6 months.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDemographic and clinical characteristics: age, sex, etiology (HBV, HCV, alcohol-related, other), tumor type (hepatocellular carcinoma, cholangiocarcinoma, mixed), tumor diameter, tumor number (solitary vs. multiple).\u003c/p\u003e\n\u003cp\u003eLaboratory parameters: conventional coagulation tests—prothrombin time (PT), activated partial thromboplastin time (APTT), international normalized ratio (INR), fibrinogen (FIB), D-dimer; platelet count (PLT); liver function tests—alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil), albumin (ALB).\u003c/p\u003e\n\u003cp\u003eThromboelastography: TEG 5000 or TEG 6s thromboelastography analyzers (Haemonetics Corp., Braintree, MA, USA) were used according to standardized protocols [14]. Parameters recorded included:\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;R time (minutes): latency time from test initiation until initial fibrin formation (amplitude reaching 2 mm); reflects coagulation factor function\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;K time (minutes): time from R time endpoint to amplitude reaching 20 mm; reflects fibrinogen function and initial clot formation kinetics\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;α-angle (degrees): slope between R and K times; represents rate of fibrin cross-linking and clot strengthening\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;MA (mm): maximum amplitude; reflects maximal clot strength determined by platelet function and fibrinogen concentration\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;CI: calculated composite index reflecting overall coagulation status (normal range: -3.0 to +3.0)\u003c/p\u003e\n\u003cp\u003eLiver functional reserve: ICGR15 measured by pulse spectrophotometry using a DDG-3300K analyzer (Nihon Kohden, Tokyo, Japan).\u003c/p\u003e\n\u003cp\u003ePathological findings: cirrhosis presence/absence, tumor differentiation grade, microvascular invasion status.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStatistical analyses were performed using SPSS version 27.0 (IBM Corp., Armonk, NY, USA). Normality of continuous variables was assessed using the Shapiro-Wilk test and visual inspection of Q-Q plots.\u003c/p\u003e\n\u003cp\u003eContinuous variables: Normally distributed data were expressed as mean ± standard deviation (SD); comparisons between two groups employed independent samples t-test, and among multiple groups used one-way analysis of variance (ANOVA) with least significant difference (LSD) post-hoc test for pairwise comparisons. Non-normally distributed data were expressed as median with interquartile range [M (P25–P75)]; comparisons between two groups used Mann-Whitney U test, and among multiple groups used Kruskal-Wallis H test with Bonferroni correction for pairwise comparisons.\u003c/p\u003e\n\u003cp\u003eCategorical variables: Presented as frequencies and percentages (n, %); comparisons between groups used chi-square test or Fisher's exact probability test as appropriate.\u003c/p\u003e\n\u003cp\u003eCorrelation analyses: Spearman's rank correlation coefficient was calculated to assess relationships between TEG parameters and conventional coagulation tests or liver function scores. Correlation strength was interpreted as: |r|\u0026lt;0.3, weak; 0.3≤|r|\u0026lt;0.6, moderate; |r|≥0.6, strong.\u003c/p\u003e\n\u003cp\u003eAll statistical tests were two-sided, and P-values \u0026lt;0.05 were considered statistically significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of The Third People's Hospital of Yunnan Province. Given the retrospective design utilizing de-identified data with no direct patient contact or interventions, the requirement for informed consent was waived by the ethics committee. All procedures complied with the ethical standards of the institutional research committee and the 1964 Helsinki Declaration and its later amendments.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eBaseline characteristics\u003c/h2\u003e \u003cp\u003eA total of 1670 PLC patients were included in the final analysis, comprising 348 (20.8%) non-cirrhotic and 1322 (79.2%) cirrhotic patients. Among cirrhotic patients, 1102 (83.4%) were Child-Pugh class A and 220 (16.6%) class B; 1084 (82.0%) had MELD score\u0026thinsp;\u0026lt;\u0026thinsp;10 and 238 (18.0%)\u0026thinsp;\u0026ge;\u0026thinsp;10; 906 (68.5%) had ICGR15\u0026thinsp;\u0026lt;\u0026thinsp;10% and 416 (31.5%)\u0026thinsp;\u0026ge;\u0026thinsp;10%. HBV infection was present in 1389 patients (83.2%), confirming HBV as the predominant etiological factor in this cohort.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents baseline characteristics stratified by cirrhosis status. Compared to non-cirrhotic patients, cirrhotic patients had significantly higher proportions of males (81.4% vs. 73.0%, P\u0026thinsp;=\u0026thinsp;0.002), hepatocellular carcinoma (97.3% vs. 72.7%, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and HBV infection (85.4% vs. 74.7%, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Tumor diameter was smaller in cirrhotic patients (5.38\u0026thinsp;\u0026plusmn;\u0026thinsp;3.42 cm vs. 6.93\u0026thinsp;\u0026plusmn;\u0026thinsp;3.87 cm, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Cirrhotic patients exhibited significantly higher AST (P\u0026thinsp;=\u0026thinsp;0.002) and total bilirubin (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) levels, while albumin levels showed no significant intergroup difference (P\u0026thinsp;=\u0026thinsp;0.058).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics of study patients stratified by cirrhosis status\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-cirrhosis (n\u0026thinsp;=\u0026thinsp;348)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCirrhosis (n\u0026thinsp;=\u0026thinsp;1322)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStatistic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55.83\u0026thinsp;\u0026plusmn;\u0026thinsp;11.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54.62\u0026thinsp;\u0026plusmn;\u0026thinsp;10.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;1.892\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.059\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u0026sup2;=9.634\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e254 (73.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1076 (81.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e94 (27.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e246 (18.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEtiology, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u0026sup2;=28.762\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHBV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e260 (74.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1129 (85.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHCV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (3.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84 (6.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHBV\u0026thinsp;+\u0026thinsp;HCV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51 (3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73 (21.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58 (4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor type, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u0026sup2;=186.534\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHepatocellular carcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e253 (72.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1286 (97.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCholangiocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e95 (27.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor diameter (cm), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.93\u0026thinsp;\u0026plusmn;\u0026thinsp;3.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.38\u0026thinsp;\u0026plusmn;\u0026thinsp;3.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;7.153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor number, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u0026sup2;=12.845\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.093\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSolitary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e258 (74.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e862 (65.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMultiple (\u0026ge;\u0026thinsp;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e90 (25.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e460 (34.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eALT (U/L), M (P25\u0026ndash;P75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27.5 (17.5\u0026ndash;44.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.5 (19.5\u0026ndash;47.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eZ=\u0026minus;0.726\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.468\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAST (U/L), M (P25\u0026ndash;P75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28.5 (20.5\u0026ndash;45.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.5 (23.5\u0026ndash;50.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eZ=\u0026minus;3.126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal bilirubin (\u0026micro;mol/L), M (P25\u0026ndash;P75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.8 (9.0\u0026ndash;16.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.5 (9.9\u0026ndash;21.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eZ=\u0026minus;4.238\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlbumin (g/L), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37.62\u0026thinsp;\u0026plusmn;\u0026thinsp;4.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.08\u0026thinsp;\u0026plusmn;\u0026thinsp;4.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;1.894\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.058\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eAbbreviations: HBV, hepatitis B virus; HCV, hepatitis C virus; ALT, alanine aminotransferase; AST, aspartate aminotransferase; SD, standard deviation.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eTEG parameters according to liver disease severity\u003c/h3\u003e\n\u003cp\u003eTEG parameters demonstrated progressive hypocoagulable alterations with increasing liver disease severity (Tables\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, and \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTEG parameters stratified by Child-Pugh class\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTEG parameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-cirrhosis (n\u0026thinsp;=\u0026thinsp;348)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCirrhosis group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eStatistic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eChild-Pugh A (n\u0026thinsp;=\u0026thinsp;1102)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eChild-Pugh B (n\u0026thinsp;=\u0026thinsp;220)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR time (min), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.63\u0026thinsp;\u0026plusmn;\u0026thinsp;1.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.85\u0026thinsp;\u0026plusmn;\u0026thinsp;1.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.69\u0026thinsp;\u0026plusmn;\u0026thinsp;1.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eF\u0026thinsp;=\u0026thinsp;3.142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.043\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eK time (min), M (P25\u0026ndash;P75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.7 (1.4\u0026ndash;2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.3 (1.8\u0026ndash;2.8)\u0026sup1;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.6 (2.1\u0026ndash;3.3)\u0026sup1;,\u0026sup2;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eH\u0026thinsp;=\u0026thinsp;96.847\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eα-angle (\u0026deg;), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65.43\u0026thinsp;\u0026plusmn;\u0026thinsp;7.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60.18\u0026thinsp;\u0026plusmn;\u0026thinsp;10.72\u0026sup1;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58.92\u0026thinsp;\u0026plusmn;\u0026thinsp;10.46\u0026sup1;,\u0026sup2;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eF\u0026thinsp;=\u0026thinsp;29.634\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMA (mm), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61.87\u0026thinsp;\u0026plusmn;\u0026thinsp;7.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55.28\u0026thinsp;\u0026plusmn;\u0026thinsp;7.48\u0026sup1;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52.86\u0026thinsp;\u0026plusmn;\u0026thinsp;10.63\u0026sup1;,\u0026sup2;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eF\u0026thinsp;=\u0026thinsp;82.156\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCI, M (P25\u0026ndash;P75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.4 (\u0026minus;0.8\u0026ndash;1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;1.1 (\u0026minus;2.4\u0026ndash;0.2)\u0026sup1;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;1.5 (\u0026minus;3.3\u0026ndash;0.4)\u0026sup1;,\u0026sup2;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eH\u0026thinsp;=\u0026thinsp;103.528\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eAbbreviations: TEG, thromboelastography; R time, reaction time; K time, clot formation time; α-angle, coagulation angle; MA, maximum amplitude; CI, coagulation index; SD, standard deviation.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u0026sup1; P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 vs. non-cirrhosis group; \u0026sup2; P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 vs. Child-Pugh A group.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTEG parameters stratified by MELD score\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTEG parameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-cirrhosis (n\u0026thinsp;=\u0026thinsp;348)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCirrhosis group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eStatistic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMELD\u0026thinsp;\u0026lt;\u0026thinsp;10 (n\u0026thinsp;=\u0026thinsp;1084)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMELD\u0026thinsp;\u0026ge;\u0026thinsp;10 (n\u0026thinsp;=\u0026thinsp;238)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR time (min), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.63\u0026thinsp;\u0026plusmn;\u0026thinsp;1.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.82\u0026thinsp;\u0026plusmn;\u0026thinsp;1.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.84\u0026thinsp;\u0026plusmn;\u0026thinsp;1.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eF\u0026thinsp;=\u0026thinsp;2.184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.113\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eK time (min), M (P25\u0026ndash;P75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.7 (1.4\u0026ndash;2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.3 (1.8\u0026ndash;2.8)\u0026sup1;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.9 (2.2\u0026ndash;3.8)\u0026sup1;,\u0026sup2;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eH\u0026thinsp;=\u0026thinsp;136.852\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eα-angle (\u0026deg;), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65.43\u0026thinsp;\u0026plusmn;\u0026thinsp;7.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60.58\u0026thinsp;\u0026plusmn;\u0026thinsp;10.64\u0026sup1;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56.43\u0026thinsp;\u0026plusmn;\u0026thinsp;10.32\u0026sup1;,\u0026sup2;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eF\u0026thinsp;=\u0026thinsp;42.386\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMA (mm), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61.87\u0026thinsp;\u0026plusmn;\u0026thinsp;7.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55.83\u0026thinsp;\u0026plusmn;\u0026thinsp;7.46\u0026sup1;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50.62\u0026thinsp;\u0026plusmn;\u0026thinsp;9.68\u0026sup1;,\u0026sup2;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eF\u0026thinsp;=\u0026thinsp;112.634\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCI, M (P25\u0026ndash;P75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.4 (\u0026minus;0.8\u0026ndash;1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;1.0 (\u0026minus;2.3\u0026ndash;0.3)\u0026sup1;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;2.2 (\u0026minus;3.9\u0026ndash;\u0026minus;0.6)\u0026sup1;,\u0026sup2;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eH\u0026thinsp;=\u0026thinsp;128.754\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eAbbreviations: MELD, Model for End-Stage Liver Disease; TEG, thromboelastography.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u0026sup1; P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 vs. non-cirrhosis group; \u0026sup2; P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 vs. MELD\u0026thinsp;\u0026lt;\u0026thinsp;10 group.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTEG parameters stratified by ICGR15 levels in cirrhotic patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTEG parameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eICGR15\u0026thinsp;\u0026lt;\u0026thinsp;10% (n\u0026thinsp;=\u0026thinsp;906)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eICGR15\u0026thinsp;\u0026ge;\u0026thinsp;10% (n\u0026thinsp;=\u0026thinsp;416)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStatistic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR time (min), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.88\u0026thinsp;\u0026plusmn;\u0026thinsp;1.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.70\u0026thinsp;\u0026plusmn;\u0026thinsp;1.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;2.386\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.017\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eK time (min), M (P25\u0026ndash;P75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.38 (1.79\u0026ndash;2.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.83 (2.01\u0026ndash;3.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eZ=\u0026minus;5.634\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eα-angle (\u0026deg;), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60.43\u0026thinsp;\u0026plusmn;\u0026thinsp;11.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58.72\u0026thinsp;\u0026plusmn;\u0026thinsp;9.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;2.418\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.016\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMA (mm), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55.86\u0026thinsp;\u0026plusmn;\u0026thinsp;7.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52.63\u0026thinsp;\u0026plusmn;\u0026thinsp;9.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;5.372\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCI, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;1.09\u0026thinsp;\u0026plusmn;\u0026thinsp;2.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;1.58\u0026thinsp;\u0026plusmn;\u0026thinsp;2.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;2.385\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.017\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eAbbreviations: ICGR15, indocyanine green retention rate at 15 minutes; TEG, thromboelastography.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eChild-Pugh classification: Compared to Child-Pugh A patients, Child-Pugh B patients exhibited significantly prolonged K time [2.6 (2.1\u0026ndash;3.3) vs. 2.3 (1.8\u0026ndash;2.8) min, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001] and reduced α-angle (58.92\u0026thinsp;\u0026plusmn;\u0026thinsp;10.46 vs. 60.18\u0026thinsp;\u0026plusmn;\u0026thinsp;10.72\u0026deg;, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), MA (52.86\u0026thinsp;\u0026plusmn;\u0026thinsp;10.63 vs. 55.28\u0026thinsp;\u0026plusmn;\u0026thinsp;7.48 mm, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and CI [-1.5 (-3.3\u0026ndash;0.4) vs. -1.1 (-2.4\u0026ndash;0.2), P\u0026thinsp;\u0026lt;\u0026thinsp;0.001] (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMELD score: Patients with MELD score\u0026thinsp;\u0026ge;\u0026thinsp;10 showed significantly prolonged K time [2.9 (2.2\u0026ndash;3.8) vs. 2.3 (1.8\u0026ndash;2.8) min, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001] and reduced α-angle (56.43\u0026thinsp;\u0026plusmn;\u0026thinsp;10.32 vs. 60.58\u0026thinsp;\u0026plusmn;\u0026thinsp;10.64\u0026deg;, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), MA (50.62\u0026thinsp;\u0026plusmn;\u0026thinsp;9.68 vs. 55.83\u0026thinsp;\u0026plusmn;\u0026thinsp;7.46 mm, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and CI [-2.2 (-3.9\u0026ndash; -0.6) vs. -1.0 (-2.3\u0026ndash;0.3), P\u0026thinsp;\u0026lt;\u0026thinsp;0.001] compared to those with MELD score\u0026thinsp;\u0026lt;\u0026thinsp;10 (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eICGR15: Patients with ICGR15\u0026thinsp;\u0026ge;\u0026thinsp;10% demonstrated significantly prolonged K time [2.83 (2.01\u0026ndash;3.52) vs. 2.38 (1.79\u0026ndash;2.79) min, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001], reduced MA (52.63\u0026thinsp;\u0026plusmn;\u0026thinsp;9.63 vs. 55.86\u0026thinsp;\u0026plusmn;\u0026thinsp;7.24 mm, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and modest but significant reductions in R time (5.70\u0026thinsp;\u0026plusmn;\u0026thinsp;1.28 vs. 5.88\u0026thinsp;\u0026plusmn;\u0026thinsp;1.27 min, P\u0026thinsp;=\u0026thinsp;0.017), α-angle (58.72\u0026thinsp;\u0026plusmn;\u0026thinsp;9.96 vs. 60.43\u0026thinsp;\u0026plusmn;\u0026thinsp;11.08\u0026deg;, P\u0026thinsp;=\u0026thinsp;0.016), and CI (-1.58\u0026thinsp;\u0026plusmn;\u0026thinsp;2.79 vs. -1.09\u0026thinsp;\u0026plusmn;\u0026thinsp;2.18, P\u0026thinsp;=\u0026thinsp;0.017) compared to those with ICGR15\u0026thinsp;\u0026lt;\u0026thinsp;10% (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eCorrelations between TEG parameters and conventional coagulation tests\u003c/h2\u003e \u003cp\u003eIn the overall cohort (n\u0026thinsp;=\u0026thinsp;1670), MA demonstrated strong positive correlations with fibrinogen (r\u0026thinsp;=\u0026thinsp;0.681, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and platelet count (r\u0026thinsp;=\u0026thinsp;0.672, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), confirming MA as a reliable integrative indicator of platelet-fibrinogen interaction (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). K time showed moderate-to-strong negative correlations with fibrinogen (r=-0.614, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and platelet count (r=-0.556, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), while α-angle exhibited moderate positive correlations with these parameters (r\u0026thinsp;=\u0026thinsp;0.583 and 0.518, respectively, both P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). CI correlated significantly with all conventional coagulation parameters, most strongly with fibrinogen (r\u0026thinsp;=\u0026thinsp;0.592, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and platelet count (r\u0026thinsp;=\u0026thinsp;0.558, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). All TEG parameters showed significant but weak-to-moderate correlations with PT, INR, and D-dimer (all P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSpearman correlations between TEG parameters and conventional coagulation tests (overall population, n\u0026thinsp;=\u0026thinsp;1670)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTEG parameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eINR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFIB\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eD-dimer\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003ePLT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;0.009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.712\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.386\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;0.094\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u0026minus;0.192\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e\u0026minus;0.108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eK time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.218\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.252\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;0.614\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e\u0026minus;0.273\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e\u0026minus;0.556\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eα-angle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;0.184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.216\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.583\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.294\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.518\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;0.273\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.312\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.681\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.289\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.672\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;0.202\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.234\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.592\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.311\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e0.558\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"11\"\u003eAbbreviations: PT, prothrombin time; INR, international normalized ratio; FIB, fibrinogen; PLT, platelet count; TEG, thromboelastography.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eCorrelations between TEG parameters and liver function scores\u003c/h2\u003e \u003cp\u003eMA showed weak but statistically significant negative correlations with Child-Pugh score (r=-0.118, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), MELD score (r=-0.256, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and ICGR15 (r=-0.121, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), indicating progressive reduction in maximal clot strength with deteriorating liver function (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e). K time, α-angle, and CI were weakly correlated with MELD score (r\u0026thinsp;=\u0026thinsp;0.228, -0.191, and \u0026minus;\u0026thinsp;0.188, respectively; all P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). R time demonstrated a weak negative correlation with ICGR15 (r=-0.085, P\u0026thinsp;=\u0026thinsp;0.003).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSpearman correlations between TEG parameters and liver function scores (overall population, n\u0026thinsp;=\u0026thinsp;1670)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTEG parameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChild-Pugh score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMELD score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eICGR15\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003er\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;0.016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.512\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.048\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.086\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;0.085\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eK time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.062\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.054\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.228\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.058\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.062\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eα-angle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;0.031\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.352\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.191\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;0.022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.468\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;0.118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.256\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;0.121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;0.064\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.052\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.188\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026minus;0.052\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.096\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eAbbreviations: Child-Pugh score, Child-Turcotte-Pugh score; MELD, Model for End-Stage Liver Disease; ICGR15, indocyanine green retention rate at 15 minutes; TEG, thromboelastography.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eImpact of HBV infection on TEG parameters\u003c/h2\u003e \u003cp\u003eHBV-infected patients (n\u0026thinsp;=\u0026thinsp;1389) exhibited significantly higher MA (56.3\u0026thinsp;\u0026plusmn;\u0026thinsp;7.7 vs. 52.9\u0026thinsp;\u0026plusmn;\u0026thinsp;8.3 mm, P\u0026thinsp;=\u0026thinsp;0.008) and CI (-1.15\u0026thinsp;\u0026plusmn;\u0026thinsp;2.48 vs. -1.68\u0026thinsp;\u0026plusmn;\u0026thinsp;2.82, P\u0026thinsp;=\u0026thinsp;0.015) compared to non-HBV-infected patients (n\u0026thinsp;=\u0026thinsp;281), indicating a relatively hypercoagulable state associated with HBV infection (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e). No significant differences were observed in R time, K time, or α-angle between groups.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of TEG parameters between HBV-infected and non-HBV-infected patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTEG parameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHBV-infected (n\u0026thinsp;=\u0026thinsp;1389)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-HBV-infected (n\u0026thinsp;=\u0026thinsp;281)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003et-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR time (min), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e5.82\u0026thinsp;\u0026plusmn;\u0026thinsp;1.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e5.78\u0026thinsp;\u0026plusmn;\u0026thinsp;1.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.483\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.629\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eK time (min), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.47\u0026thinsp;\u0026plusmn;\u0026thinsp;1.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.53\u0026thinsp;\u0026plusmn;\u0026thinsp;1.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;0.786\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.432\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eα-angle (\u0026deg;), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e60.43\u0026thinsp;\u0026plusmn;\u0026thinsp;10.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e59.82\u0026thinsp;\u0026plusmn;\u0026thinsp;10.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.864\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.388\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMA (mm), mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e56.3\u0026thinsp;\u0026plusmn;\u0026thinsp;7.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e52.9\u0026thinsp;\u0026plusmn;\u0026thinsp;8.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.684\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCI, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;1.15\u0026thinsp;\u0026plusmn;\u0026thinsp;2.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;1.68\u0026thinsp;\u0026plusmn;\u0026thinsp;2.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;1.68\u0026thinsp;\u0026plusmn;\u0026thinsp;2.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eAbbreviations: HBV, hepatitis B virus; TEG, thromboelastography; MA, maximum amplitude; CI, coagulation index; SD, standard deviation.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis large retrospective cohort study systematically characterized TEG parameters in 1670 PLC patients stratified by cirrhosis severity and HBV infection status, demonstrating that TEG sensitively detects both hypocoagulable alterations associated with progressive liver dysfunction and hypercoagulable tendencies specifically related to HBV infection. These findings extend current understanding of coagulation dysfunction in PLC and support the clinical utility of TEG for individualized perioperative coagulation management.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTEG parameters reflect cirrhosis progression-related hypocoagulability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur results demonstrate progressive hypocoagulable alterations in TEG parameters with increasing liver disease severity. Patients with advanced cirrhosis (Child-Pugh B, MELD ≥10, or ICGR15 ≥10%) exhibited significantly prolonged K time and reduced α-angle, MA, and CI compared to those with compensated cirrhosis. These findings align with the conceptual framework of \"rebalanced hemostasis\" in liver disease, wherein parallel reductions in procoagulant and anticoagulant factors maintain hemostatic equilibrium in compensated cirrhosis, but progressive hepatic synthetic dysfunction ultimately disrupts this balance, leading to net hypocoagulability [4, 15].\u003c/p\u003e\n\u003cp\u003eNotably, patients with MELD score ≥10 demonstrated mean MA of 50.62±9.68 mm, falling below the clinically relevant threshold of 55 mm proposed by de Pietri et al. [12] for guiding prophylactic intervention before invasive procedures. This observation suggests that MELD score ≥10 identifies a high-risk subgroup warranting comprehensive hemostatic assessment and potential preemptive measures to mitigate bleeding complications during surgical interventions.\u003c/p\u003e\n\u003cp\u003eThe strong correlations between MA and both fibrinogen (r=0.681) and platelet count (r=0.672) corroborate MA as an integrative parameter reflecting platelet-fibrinogen interaction and clot strength. Fibrinogen, synthesized exclusively by hepatocytes, and platelets, which may be reduced due to hypersplenism and impaired thrombopoietin production in cirrhosis, constitute critical determinants of hemostatic competence [16, 17]. Our findings support the concept that adequate fibrinogen levels and platelet function are essential for maintaining clot integrity in cirrhotic patients, and that MA provides clinically relevant information beyond isolated measurement of these components [18].\u003c/p\u003e\n\u003cp\u003eThe significant associations between TEG parameters and ICGR15—a quantitative measure of hepatic functional reserve—extend previous observations by demonstrating that TEG abnormalities correlate not only with static disease severity scores but also with dynamic liver function capacity. This finding suggests potential utility of TEG in preoperative risk stratification, complementing established metrics such as Child-Pugh and MELD scores.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHBV infection confers a hypercoagulable tendency\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe most striking finding of this study is the significantly higher MA and CI observed in HBV-infected compared to non-HBV-infected PLC patients, indicating a relative hypercoagulable state associated with chronic HBV infection. This observation has important clinical implications given that HBV accounts for approximately 80% of PLC cases in China and other endemic regions.\u003c/p\u003e\n\u003cp\u003eThe hypercoagulability in HBV-related PLC likely reflects multifactorial mechanisms [19-21]:\u003c/p\u003e\n\u003cp\u003eDirect viral effects: HBV X protein (HBx) transactivates tissue factor gene expression via NF-κB and AP-1 signaling pathways, promoting extrinsic pathway activation [5, 22]. HBx also upregulates plasminogen activator inhibitor-1 (PAI-1), impairing fibrinolytic capacity [23].\u003c/p\u003e\n\u003cp\u003eEndothelial dysfunction: Chronic HBV infection induces systemic inflammation and endothelial injury, resulting in excessive vWF release from Weibel-Palade bodies. Concurrently, HBV suppresses ADAMTS13 synthesis and activity, leading to accumulation of ultra-large vWF multimers that promote platelet adhesion and aggregation under shear stress [6, 24].\u003c/p\u003e\n\u003cp\u003ePlatelet hyperreactivity: HBV antigens directly interact with platelet surface receptors, inducing activation and degranulation. Elevated levels of soluble P-selectin and platelet-derived microparticles have been documented in chronic hepatitis B patients, correlating with disease activity [25].\u003c/p\u003e\n\u003cp\u003eProcoagulant microparticles: HBV infection increases circulating tissue factor-bearing microparticles derived from activated platelets, endothelial cells, and monocytes, providing an additional procoagulant surface for thrombin generation [26].\u003c/p\u003e\n\u003cp\u003eInflammation-coagulation crosstalk: The chronic inflammatory state characteristic of HBV infection upregulates proinflammatory cytokines (IL-6, TNF-α) that simultaneously enhance coagulation through tissue factor induction and impair anticoagulant pathways [27].\u003c/p\u003e\n\u003cp\u003eThe clinical relevance of HBV-associated hypercoagulability warrants emphasis. Patients with HBV-related PLC and elevated MA (particularly \u0026gt;65 mm) may face increased risk of portal vein thrombosis (PVT), a complication occurring in 10–40% of HCC patients with significantly worse prognosis [28, 29]. PVT can compromise portal flow, exacerbate portal hypertension, limit treatment options, and directly impact survival. Therefore, heightened vigilance for thrombotic complications and consideration of thromboprophylaxis strategies may be appropriate in selected high-risk HBV-related PLC patients, particularly those with additional prothrombotic risk factors such as advanced age, immobilization, or active systemic therapy [30].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComparative value of TEG versus conventional coagulation tests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur correlation analyses demonstrated significant associations between TEG parameters and conventional coagulation tests, yet the modest correlation coefficients (generally r\u0026lt;0.6 for most comparisons except MA with fibrinogen/platelets) highlight the complementary rather than interchangeable nature of these assays. TEG offers distinct advantages by providing a global assessment of hemostasis that integrates plasma coagulation, platelet function, and clot stability under conditions approximating whole blood physiology [11, 31].\u003c/p\u003e\n\u003cp\u003eSeveral studies have documented substantial discrepancies between TEG and conventional coagulation tests in cirrhotic patients. Ambulkar et al. [32] prospectively evaluated 68 patients undergoing major liver resection and found that 56% of patients with prolonged INR had normal TEG parameters; reliance on INR would have prompted unnecessary blood product administration. Similarly, Gaspari et al. [33] using the newer generation TEG 6s device reported that only 10.5% of patients with abnormal conventional coagulation tests demonstrated corresponding TEG abnormalities, and TEG-defined coagulopathy correlated better with actual perioperative bleeding than conventional parameters.\u003c/p\u003e\n\u003cp\u003eThe implications for clinical practice are substantial. Indiscriminate correction of abnormal PT/INR in cirrhotic patients frequently results in unnecessary transfusion, exposing patients to risks of volume overload, transfusion reactions, and immunomodulation without proven hemostatic benefit [34, 35]. Conversely, conventional tests fail to identify the hypercoagulable phenotype associated with HBV infection, potentially missing opportunities for thromboprophylaxis. TEG-based algorithms have demonstrated efficacy in reducing blood product utilization during liver transplantation and other invasive procedures in cirrhotic patients without increasing bleeding complications [12, 36].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical implications and proposed management algorithm\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBased on our findings integrated with current evidence, we propose the following risk-stratified approach to perioperative coagulation management in PLC patients:\u003c/p\u003e\n\u003cp\u003ePreoperative risk stratification: All PLC patients with cirrhosis should undergo baseline TEG assessment. Those with Child-Pugh class B/C, MELD score ≥10, or ICGR15 ≥10% represent high-risk populations for hypocoagulability warranting particular attention.\u003c/p\u003e\n\u003cp\u003eTransfusion triggers: Based on established thresholds [12, 37], consider prophylactic intervention when:\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;MA \u0026lt;55 mm: evaluate for platelet transfusion or desmopressin (if platelet dysfunction suspected)\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;K time prolonged with reduced α-angle and fibrinogen \u0026lt;150–200 mg/dL: consider cryoprecipitate or fibrinogen concentrate\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;R time prolonged with elevated INR: consider fresh frozen plasma or prothrombin complex concentrate, though isolated R time prolongation without other abnormalities may not require correction\u003c/p\u003e\n\u003cp\u003eThrombosis surveillance: For HBV-related PLC patients with MA \u0026gt;65 mm and/or CI \u0026gt;+3.0, consider:\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Preoperative Doppler ultrasound screening for PVT\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Enhanced postoperative thrombosis surveillance, particularly if additional risk factors present\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Individualized assessment of thromboprophylaxis risk-benefit, weighing thrombotic risk against bleeding propensity\u003c/p\u003e\n\u003cp\u003ePostoperative monitoring: Patients with impaired hepatic reserve (ICGR15 ≥10%) should undergo serial TEG monitoring postoperatively, as liver dysfunction may worsen following resection, exacerbating coagulation abnormalities.\u003c/p\u003e\n\u003cp\u003eThis algorithm aligns with evolving international guidelines. The 2023 European Association for the Study of the Liver (EASL) clinical practice guidelines on coagulation in cirrhosis emphasize the value of viscoelastic testing for guiding hemostatic interventions and recommend against routine correction of coagulation parameters based solely on conventional tests [38]. Similarly, the 2024 Chinese guidelines on hepatocellular carcinoma management highlight the importance of comprehensive coagulation assessment in treatment planning [39].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy strengths and limitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study has several strengths, including the large sample size (n=1670) enabling robust subgroup analyses, comprehensive characterization of both cirrhosis severity and HBV infection status, and systematic evaluation of correlations between TEG parameters and multiple clinically relevant indices. The inclusion of ICGR15 as a quantitative measure of hepatic functional reserve extends previous observations linking TEG abnormalities to liver dysfunction.\u003c/p\u003e\n\u003cp\u003eSeveral limitations warrant consideration. First, the retrospective single-center design introduces potential selection bias and limits causal inference. The observed associations between TEG parameters and clinical characteristics cannot establish predictive value for patient-important outcomes such as bleeding events, thrombotic complications, or mortality. Second, we lacked longitudinal follow-up data to assess relationships between TEG parameters and long-term clinical outcomes. Third, the study period spanned five years during which surgical techniques and perioperative management may have evolved, potentially introducing temporal bias. Fourth, while we identified significant differences between HBV-infected and non-HBV-infected patients, the non-HBV group was heterogeneous, comprising patients with HCV infection, alcohol-related liver disease, and other etiologies, limiting specific comparisons. Fifth, we did not perform multivariable regression analyses to adjust for potential confounders such as tumor stage, portal hypertension severity, or concurrent medications. Finally, the proposed management algorithm requires prospective validation to establish its impact on clinical outcomes and cost-effectiveness.\u003c/p\u003e\n\u003cp\u003eFuture multicenter prospective studies should evaluate whether TEG-guided management strategies reduce bleeding complications, thrombotic events, and unnecessary transfusions in PLC patients undergoing surgical intervention, and whether integration of TEG parameters with established prognostic scores improves risk prediction and guides individualized therapy.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThromboelastography sensitively identifies cirrhosis progression-related hypocoagulability and HBV infection-related hypercoagulability in patients with primary liver cancer. TEG parameters, particularly maximum amplitude, demonstrate strong correlations with fibrinogen and platelet count while providing integrated assessment of global hemostatic function beyond conventional coagulation tests. These findings support the incorporation of TEG into routine perioperative coagulation assessment for PLC patients, enabling individualized risk stratification and targeted management of both bleeding and thrombotic complications.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePLC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePrimary liver cancer\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTEG\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eThromboelastography\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHBV\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHepatitis B virus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMELD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eModel for End-Stage Liver Disease\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eICGR15\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIndocyanine green retention rate at 15 minutes\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eProthrombin time\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eINR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInternational normalized ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAPTT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eActivated partial thromboplastin time\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eFIB\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFibrinogen\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePLT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePlatelet count\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMaximum amplitude\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCoagulation index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eR time\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eReaction time\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eK time\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eClot formation time\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003evWF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003evon Willebrand factor\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePVT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePortal vein thrombosis\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStandard deviation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIQR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInterquartile range.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYFW and ZDL contributed equally to this work. YFW, XS, ZDL, and SZ made substantial contributions to the conception and design of the study, critical manuscript review and revisions, and study interpretation. YFW, ZDL, and SZ performed data acquisition, analysis, and interpretation, as well as technical and material support. YFW and XS drafted the initial manuscript. All authors read and approved the final manuscript. The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Yunnan Health Training Project of High-Level Talents (Grant No. D-2024049) and the Yunnan Province High-Level Scientific and Technological Talents and Innovation Team Selection Special\u0026mdash;Young and Middle-Aged Academic and Technical Leaders Reserve Talent Project (Grant No. 202405AC350067). The funding bodies played no role in the design of the study, collection, analysis, and interpretation of data, or in writing the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data generated and analyzed during this study are not publicly available due to the inclusion of information that could compromise the privacy of research participants but are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of The Third People\u0026apos;s Hospital of Yunnan Province (Approval No.: YNSY-EC-2025-068). Due to the retrospective nature of the study utilizing de-identified patient data from medical records, the requirement for informed consent was waived by the ethics committee. This waiver is in accordance with the Chinese national regulations for ethical review of biomedical research involving humans (Article 39 of the \u0026lsquo;Measures for the Ethical Review of Biomedical Research Involving Humans\u0026rsquo;). All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. 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DOI: 10.1161/CIRCRESAHA.110.233056\u003c/li\u003e\n\u003cli\u003eEsmon CT. The interactions between inflammation and coagulation. Br J Haematol. 2005;131(4):417-430. DOI: 10.1111/j.1365-2141.2005.05753.x\u003c/li\u003e\n\u003cli\u003eAmbrosino P, Tarantino L, Di Minno G, et al. The risk of venous thromboembolism in patients with cirrhosis. A systematic review and meta-analysis. Thromb Haemost. 2017;117(1):139-148. DOI: 10.1160/TH16-06-0450\u003c/li\u003e\n\u003cli\u003eIntagliata NM, Caldwell SH, Tripodi A. Diagnosis, development, and treatment of portal vein thrombosis in patients with and without cirrhosis. Gastroenterology. 2019;156(6):1582-1599.e1. DOI: 10.1053/j.gastro.2019.01.265\u003c/li\u003e\n\u003cli\u003eZhu 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. JAMA. 2014;312(1):57-67. DOI: 10.1001/jama.2014.7189\u003c/li\u003e\n\u003cli\u003eGoyal S, Jadaun S, Kedia S, et al. Thromboelastography parameters in patients with acute on chronic liver failure. Ann Hepatol. 2018;17(6):1042-1051. DOI: 10.5604/01.3001.0012.7205\u003c/li\u003e\n\u003cli\u003eAmbulkar R, Silva W, Shetty G, et al. Evaluation of perioperative routine coagulation testing versus thromboelastography for major liver resection - A single-arm, prospective, interventional trial (PORTAL trial). Indian J Anaesth. 2023;67(12):1077-1083. DOI: 10.4103/ija.ija_344_23\u003c/li\u003e\n\u003cli\u003eGaspari R, Aceto P, Carelli S, et al. Discrepancy between conventional coagulation tests and thromboelastography during the early postoperative phase of liver resection in neoplastic patients: a prospective study using the new-generation TEG\u0026reg;6s. J Clin Med. 2025;14(9):2866. DOI: 10.3390/jcm14092866\u003c/li\u003e\n\u003cli\u003eMpaili E, Tsakanatos K, Karamagiolis S, et al. Utility of viscoelastic coagulation testing in liver surgery: a systematic review. HPB (Oxford). 2021;23(3):331-343. DOI: 10.1016/j.hpb.2020.10.023\u003c/li\u003e\n\u003cli\u003eKozek-Langenecker SA, Afshari A, Albaladejo P, et al. Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol. 2013;30(6):270-382. DOI: 10.1097/EJA.0b013e32835f4d5b\u003c/li\u003e\n\u003cli\u003eLiu B, Zhang Q, Zhang J. Guiding role of thromboelastography in clinical blood transfusion in patients with coagulation dysfunction after liver cancer surgery and its effect on coagulation indexes and blood coagulation quality. J Clin Exp Med. 2025;24(7):754-758. DOI: 10.3969/j.issn.1671-4695.2025.07.021\u003c/li\u003e\n\u003cli\u003eZhu 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. Exp Ther Med. 2020;20(3):2657-2664. DOI: 10.3892/etm.2020.8990\u003c/li\u003e\n\u003cli\u003eEuropean Association for the Study of the Liver. EASL Clinical Practice Guidelines on prevention and management of bleeding and thrombosis in patients with cirrhosis. J Hepatol. 2022;76(5):1151-1184. DOI: 10.1016/j.jhep.2021.09.003\u003c/li\u003e\n\u003cli\u003eXie DY, Zhu K, Ren ZG, et al. A review of 2022 Chinese clinical guidelines on the management of hepatocellular carcinoma: updates and insights. Hepatobiliary Surg Nutr. 2023;12(2):216-228. DOI: 10.21037/hbsn-22-469\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcan","sideBox":"Learn more about [BMC Cancer](http://bmccancer.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcan/default.aspx","title":"BMC Cancer","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Liver neoplasms, Liver cirrhosis, Hepatitis B virus, Thromboelastography, Blood coagulation","lastPublishedDoi":"10.21203/rs.3.rs-9001317/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9001317/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePatients with primary liver cancer (PLC) often present with complex coagulation disorders due to underlying liver disease. Conventional coagulation tests inadequately reflect the comprehensive hemostatic status. This study aimed to investigate the clinical characteristics of thromboelastography (TEG) parameters in PLC patients and evaluate their value in assessing coagulation function.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe retrospectively enrolled 1670 PLC patients who underwent surgical treatment at The Third People's Hospital of Yunnan Province between January 2020 and December 2025. Patients were stratified by cirrhosis status (non-cirrhosis, n\u0026thinsp;=\u0026thinsp;348; cirrhosis, n\u0026thinsp;=\u0026thinsp;1322), hepatitis B virus (HBV) infection status (HBV-infected, n\u0026thinsp;=\u0026thinsp;1389; non-HBV-infected, n\u0026thinsp;=\u0026thinsp;281), and liver disease severity based on Child-Pugh class, MELD score, and indocyanine green retention rate at 15 min (ICGR15). TEG parameters (R time, K time, α-angle, maximum amplitude [MA], coagulation index [CI]) and conventional coagulation tests were measured. Statistical analyses included t-tests, Mann-Whitney U tests, ANOVA, Kruskal-Wallis H tests, chi-square tests, and Spearman correlation analyses.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAmong cirrhotic patients (n\u0026thinsp;=\u0026thinsp;1322), 1102 were Child-Pugh class A and 220 class B; 1084 had MELD score\u0026thinsp;\u0026lt;\u0026thinsp;10 and 238\u0026thinsp;\u0026ge;\u0026thinsp;10; 906 had ICGR15\u0026thinsp;\u0026lt;\u0026thinsp;10% and 416\u0026thinsp;\u0026ge;\u0026thinsp;10%. Compared to Child-Pugh A patients, class B patients exhibited significantly prolonged K time, and reduced α-angle, MA, and CI (all P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Similar trends were observed in patients with MELD score\u0026thinsp;\u0026ge;\u0026thinsp;10 versus \u0026lt;\u0026thinsp;10, and ICGR15\u0026thinsp;\u0026ge;\u0026thinsp;10% versus \u0026lt;\u0026thinsp;10% (all P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). MA showed strong positive correlations with fibrinogen (r\u0026thinsp;=\u0026thinsp;0.681, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and platelet count (r\u0026thinsp;=\u0026thinsp;0.672, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). MA was weakly negatively correlated with Child-Pugh score (r=-0.118, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), MELD score (r=-0.256, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and ICGR15 (r=-0.121, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). HBV-infected patients demonstrated significantly higher MA and CI compared to non-HBV-infected patients (both P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eTEG sensitively identifies cirrhosis progression-related hypocoagulability and HBV-related hypercoagulability in PLC patients, providing valuable guidance for individualized perioperative coagulation management.\u003c/p\u003e","manuscriptTitle":"Thromboelastographic Parameters in Patients with Primary Liver Cancer: Clinical Characteristics and Value in Assessing Coagulation Function","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-27 09:55:55","doi":"10.21203/rs.3.rs-9001317/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-03-25T09:20:21+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-23T08:09:16+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-04T08:54:37+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-03T13:28:04+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Cancer","date":"2026-03-03T09:01:25+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcan","sideBox":"Learn more about [BMC Cancer](http://bmccancer.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcan/default.aspx","title":"BMC Cancer","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"037094d0-e296-4f0e-9dc9-b229ab447c05","owner":[],"postedDate":"March 27th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-27T09:55:55+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-27 09:55:55","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9001317","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9001317","identity":"rs-9001317","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}