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We evaluated the influence of the hepatic venous pressure gradient (HVPG) on ROTEM results in patients with ACLD.\n<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Cross-sectional study; ACLD patients undergoing HVPG measurement within the prospective Vienna Cirrhosis Study (NCT03267615) underwent concomitant ROTEM testing.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Among 159 patients (68% male; Child\u2013Pugh-A: 53%, Child\u2013Pugh-B: 34%, Child\u2013Pugh-C: 13%), 21 patients (13%) had a HVPG between 6 and 10\u00a0mmHg, 84 patients (53%) between 10 and 19\u00a0mmHg, and 54 patients (34%)\u2009\u2265\u200920\u00a0mmHg. Child\u2013Pugh-C patients (vs. Child\u2013Pugh-A and vs. Child\u2013Pugh-B patients, respectively) showed longer clot formation time (CFT: median 187\u00a0s vs. 122\u00a0s vs. 122\u00a0s, <jats:italic>p<\/jats:italic>\u2009=\u20090.007) and lower maximum clot firmness (MCF: median: 45\u00a0mm vs. 56\u00a0mm vs. 56\u00a0mm, <jats:italic>p<\/jats:italic>\u2009=\u20090.002) in extrinsic thromboelastometry (EXTEM), while platelet counts were similar across Child\u2013Pugh stages. In the overall cohort, ROTEM parameters did not differ by severity of portal hypertension. However, among compensated Child\u2013Pugh-A patients, MCF decreased with increasing portal pressure, i.e. in higher HVPG strata (HVPG 9\u201310\u00a0mmHg: median MCF: 59\u00a0mm vs. HVPG 10\u201319\u00a0mmHg: 56\u00a0mm vs HVPG\u2009\u2265\u200920\u00a0mmHg: 54\u00a0mm, <jats:italic>p<\/jats:italic>\u2009=\u20090.023). Furthermore, patients with short CFT and high MCF in EXTEM had higher levels of lipopolysaccharide-binding protein, C-reactive protein, and procalcitonin, as well as higher leukocyte counts (all <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Portal hypertension seems to impact ROTEM results only in compensated Child\u2013Pugh-A patients. Bacterial translocation and systemic inflammation may trigger a procoagulant state in patients with ACLD.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s12072-020-10093-3","type":"journal-article","created":{"date-parts":[[2020,9,30]],"date-time":"2020-09-30T22:37:36Z","timestamp":1601505456000},"page":"1083-1092","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Thromboelastometry in patients with advanced chronic liver disease stratified by severity of portal hypertension"],"prefix":"10.1007","volume":"14","author":[{"given":"Pierre","family":"Raeven","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna","family":"Baron-Stefaniak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benedikt","family":"Simbrunner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Stadlmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Schwabl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard","family":"Scheiner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Schaden","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ernst","family":"Eigenbauer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Quehenberger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mattias","family":"Mandorfer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David Marek","family":"Baron","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4590-3583","authenticated-orcid":false,"given":"Thomas","family":"Reiberger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,9,30]]},"reference":[{"issue":"2","key":"10093_CR1","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1056\/NEJMra1011170","volume":"365","author":"A Tripodi","year":"2011","unstructured":"Tripodi A, Mannucci PM. 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P.S. received speaking honoraria from Bristol-Myers Squibb and Boehringer-Ingelheim, consulting fees from PharmaIN, and travel support from Falk. M.M. served as a speaker and\/or consultant and\/or advisory board member for AbbVie, Bristol-Myers Squibb, Gilead, and W. L. Gore & Associates and received travel support from AbbVie, Bristol-Myers Squibb, and Gilead. T.R. received grant support from AbbVie, Boehringer-Ingelheim, Gilead, MSD, Philips Healthcare, Gore; speaking honoraria from AbbVie, Gilead, Gore, Intercept, Roche, MSD; consulting\/advisory board fee from AbbVie, Bayer, Boehringer-Ingelheim, Gilead, Intercept, MSD, Siemens; and travel support from Boehringer-Ingelheim, Gilead and Roche. None of the remaining authors declares a conflict of interest for this manuscript.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional review board of the Medical University of Vienna (1262\/2017) and with the 1964 Helsinki declaration and its later amendments.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}