Thromboelastometry in patients with severe sepsis and disseminated intravascular coagulation.
Severe sepsis induces coagulopathy, which may lead to disseminated intravascular coagulation (DIC). Thromboelastometry is a point-of-care whole blood coagulation monitor, which has been validated in human endotoxemia model. We assessed thromboelastometry in severe sepsis and overt DIC and investigated its applicability in differentiating sepsis-related coagulation disturbances. Thromboelastometry (EXTEM and FIBTEM tests) and traditional coagulation assays were analyzed in 28 patients with severe sepsis, 12 of who fulfilled the criteria of overt DIC on admission. Ten healthy persons served as controls. Coagulation parameters, clotting time, clot formation time (CFT), alpha angle, maximal clot firmness (MCF) and lysis index at 60 min, were registered. In patients with overt DIC, EXTEM MCF, CFT and alpha angle differed from that in both healthy controls and patients without DIC, indicating hypocoagulation (MCF 52, 63 and 68 mm; CFT 184, 88 and 73 s; and alpha angle 58, 72 and 76 degrees , respectively, P < 0.01 for all). In patients without DIC, the trend was toward hypercoagulation in EXTEM and FIBTEM MCF (68 vs. 63 mm, P = 0.042 and 23 vs. 15 mm, P = 0.034, respectively). Receiver operating characteristic curves showed that MCF, CFT and alpha angle discriminated patients with overt DIC moderately (area under curve 0.891, 0.815 and 0.828, respectively, P < 0.001 for all). Traditional coagulation assays showed progressively worsening coagulopathy from controls to septic patients without DIC and further to those with overt DIC. We conclude that thromboelastometry may be a valuable tool in assessing whole blood coagulation capacity in patients with severe sepsis with and without overt DIC.
Sivula
Mirka
M
Intensive Care Units, Department of Anesthesiology and Intensive Care Medicine, Helsinki University Hospital, Helsinki, Finland. mirka.sivula@hus.fi
Pettilä
Ville
V
Niemi
Tomi T
TT
Varpula
Marjut
M
Kuitunen
Anne H
AH
D000328:Adult; D001780:Blood Coagulation Tests; D003937:Diagnosis, Differential; D018450:Disease Progression; D004211:Disseminated Intravascular Coagulation / Q000097:blood* / Q000209:etiology; D005260:Female; D006474:Hemorrhagic Disorders / Q000097:blood* / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D012372:ROC Curve; D018805:Sepsis / Q000097:blood* / Q000150:complications; D013916:Thrombelastography; D019851:Thrombophilia / Q000097:blood* / Q000175:diagnosis / Q000209:etiology