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Leveraging Turbidity and Thromboelastography for Complementary Clot Characterization
Published on: June 4, 2020
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Thromboelastography in patients with severe sepsis: a prospective cohort study
Nicolai Haase1, Sisse Rye Ostrowski, Jørn Wetterslev
1Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark, nicolai.rosenkrantz.segelcke.haase@regionh.dk.
Intensive Care Medicine
|November 22, 2014
Summary
Progressive hypocoagulability, measured by thromboelastography (TEG) in severe sepsis patients, significantly increases the risk of death and bleeding. These findings highlight TEG
Area of Science:
- Critical Care Medicine
- Hematology
- Sepsis Pathophysiology
Background:
- Severe sepsis poses a significant threat, with coagulopathy being a common and dangerous complication.
- Thromboelastography (TEG) provides a dynamic assessment of hemostasis, but its utility in predicting outcomes in sepsis requires further investigation.
- Understanding the relationship between evolving coagulation parameters and patient outcomes is crucial for timely intervention.
Purpose of the Study:
- To examine the association between serial thromboelastographic (TEG) measurements and patient outcomes, specifically death and bleeding, in severe sepsis.
- To evaluate whether changes in TEG parameters over time correlate with prognosis in critically ill septic patients.
Main Methods:
- A prospective observational study involving a subgroup of the Scandinavian Starch for Severe Sepsis/Septic Shock (6S) Trial.
- Consecutive TEG (standard and functional fibrinogen) measurements were performed for up to 5 days in patients receiving hydroxyethyl starch (HES) or Ringer's acetate.
- Cox regression with time-dependent covariates and joint modeling were used to analyze the association between TEG variables and clinical outcomes (bleeding, death).
Main Results:
- Of 260 analyzed patients, 53% died and 26% experienced bleeding within 90 days.
- Hypocoagulability on TEG was significantly associated with an increased risk of death, with deteriorations in clot formation, angle, strength, and fibrinogen contribution all increasing mortality risk.
- Patients treated with HES exhibited lower functional fibrinogen maximum amplitude (MA), which was linked to a significantly higher risk of bleeding.
Conclusions:
- Progressive hypocoagulability, as detected by serial TEG variables, is a significant predictor of increased mortality in severe sepsis patients.
- TEG-derived hypocoagulability also correlates with an elevated risk of bleeding, particularly in patients treated with HES.
- These findings underscore the prognostic value of dynamic coagulation assessment using TEG in severe sepsis management.
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