Viscoelastic and aggregometric point-of-care testing in patients with septic shock - cross-links between inflammation and haemostasis.
BACKGROUND
In the pathogenesis of sepsis, inflammation-induced changes in coagulation play a pivotal role.


METHODS
In total, 90 patients (30 patients with septic shock, 30 surgical patients following major abdominal surgery and 30 healthy volunteers) were enrolled. Blood samples from patients with septic shock were collected at the time of sepsis diagnosis as well as 24 h, 4 days, 7 days, 14 days and 28 days later. Samples from surgical patients with a post-surgical inflammatory response were collected three times (before surgery, immediately after surgery and 24 h after surgery) and once from healthy volunteers. Thromboelastometry (ROTEM (®) ), as well as whole blood impedance aggregometry (Multiplate(®) ) were performed. Additionally, plasma concentrations of interleukin-6 and tumour necrosis factor-alpha were measured using enzyme-linked immunosorbent assay kits.


RESULTS
Thromboelastometry lysis index was shown to be a reliable biomarker for septic shock. Furthermore, in septic patients with overt disseminated intravascular coagulation, thromboelastometry revealed signs indicating a hypocoagulable status, whereas patients without overt disseminated intravascular coagulation were found to be hypercoagulable. Platelet aggregation capability, as assessed by whole blood impedance aggregometry, was significantly reduced in septic patients with overt disseminated intravascular coagulation, whereas it was comparable with healthy volunteers and in septic patients without overt disseminated intravascular coagulation.


CONCLUSIONS
Viscoelastic and aggregometric point-of-care testing was shown to be potentially useful for bedside diagnosis of sepsis. Moreover, viscoelastic and aggregometric point-of-care testing was able to determine the phase of septic coagulopathy (hypercoagulability vs. hypocoagulability) and therefore identified patients at high risk for overt disseminated intravascular coagulation.
Department of Anaesthesiology, University of Heidelberg, Heidelberg, Germany. thorsten.brenner@med.uni-heidelberg.de
T
T
Brenner
K
K
Schmidt
M
M
Delang
A
A
Mehrabi
T
T
Bruckner
C
C
Lichtenstern
E
E
Martin
M A
MA
Weigand
S
S
Hofer
D018806:APACHE; D000368:Aged; D019540:Area Under Curve; D001778:Blood Coagulation Disorders / Q000097:blood; D001779:Blood Coagulation Factors / Q000032:analysis; D001809:Blood Viscosity; D004211:Disseminated Intravascular Coagulation / Q000097:blood / Q000175:diagnosis; D005260:Female; D006487:Hemostasis / Q000502:physiology*; D006801:Humans; D007249:Inflammation / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D010974:Platelet Aggregation; D019095:Point-of-Care Systems; D011183:Postoperative Complications / Q000097:blood; D012772:Shock, Septic / Q000097:blood*; D016019:Survival Analysis; D013916:Thrombelastography; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
D001779:Blood Coagulation Factors; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha