Thromboelastogram may predict severity of organ dysfunction in sepsis, finds study
Recent research reports have put forth that a subset of patients with severe sepsis without overt bleeding are hypocoagulable and can be successfully detected by thromboelastogram. The study, published in Journal of Critical Care, has further affirmed that hypocoagulability is associated with mortality and need for transfusion.
Coagulation abnormalities are not infrequent in sepsis.to date, it is unclear if abnormalities in thromboelastogram (TEG) are associated with mortality in patients with severe sepsis without overt bleeding.
In this prospective study, patients were categorised as those with normal coagulation, hypercoagulable or hypercoagulable state based on admission TEG parameters (R time, K time, Maximum amplitude (MA), α angle). Their association with mortality was explored using Fisher's exact and Mann-Whitney U test as appropriate.
Results highlighted some key facts.
- The study cohort (n = 87; 49 male) with median (IQR) age 51 (42–60) years and admission SOFA score 8 (6–11) included scrub typhus (24.1%), pneumonia (22.6%) and urosepsis (10.3%).
- Non-invasive and invasive ventilation and vasopressors were required in 28.1%, 68.9% and 74%, respectively.
- Mortality was 24.1%. Based on R time, K time and α angle, 3.5% to 9.3% had a hypercoagulable state and 26.7 to 29.9% were hypocoagulable.
- Prolonged R time (p = 0.04) and reduced alpha angle (p = 0.01) in patients with hypocoagulable state was associated with mortality.
- K time, α angle and MA were significantly different in patients requiring transfusion (p < 0.001).
The key highlights of the result are –
- Coagulation abnormalities are frequent in patients with sepsis with organ dysfunction even in the absence of overt bleeding.
- Thromboelastogram correlated with severity of organ dysfunction and subsequent transfusion requirement in these patients.
- Thromboelastogram may be useful in the prognostication of patients with sepsis without overt bleeding.
"Overall observations support the correlation of thromboelastogram with severity of organ dysfunction and subsequent transfusion requirement in these patients. They suggest a possible utility of thromboelastogram in the prognostication of patients with sepsis without overt bleeding."the team concluded.
For full article follow the link: https://doi.org/10.1016/j.jcrc.2021.06.005
Source: Journal of Critical Care
