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Diagnostic Value of Thromboelastography (TEG) for the Diagnosis of Death in Infected Patients

Jingchao Xuan1, Junyu Wang1, Bing Wei1

  • 1Emergency Medicine Clinical Research Center, Beijing Chao-Yang Hospital, Capital Medical University, & Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Capital Medical University, Beijing, China.

Clinical and Applied Thrombosis/Hemostasis : Official Journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis
|October 18, 2021
PubMed

Insights

Thromboelastography (TEG) indices show high specificity but low sensitivity for predicting death in infected patients. Factors like granulocytes, thrombocytes, and platelet distribution width independently influence mortality risk.

Area of Science:

  • Critical Care Medicine
  • Hematology
  • Diagnostic Medicine

Background:

  • Infection significantly impacts patient prognosis, with coagulopathy being a critical factor.
  • Thromboelastography (TEG) assesses hemostasis, but its prognostic value in infected patients requires further elucidation.
  • Biomarkers like C-reactive protein (CRP) and procalcitonin (PCT) are established indicators of infection severity.

Purpose of the Study:

  • To evaluate the clinical utility of individual thromboelastography (TEG) parameters in predicting mortality among infected patients.
  • To determine the independent prognostic factors for death in infected patients.
  • To compare the diagnostic efficacy of TEG-based models with established inflammatory markers.

Main Methods:

  • Retrospective analysis of clinical data and TEG results from 431 infected emergency department patients.
  • Correlation analysis between TEG parameters, CRP, and PCT.
  • Multifactorial regression analysis to identify independent predictors of mortality.
  • Assessment of the diagnostic performance (sensitivity, specificity, AUC) of TEG indices and combined models.

Main Results:

  • CRP correlated positively with maximum amplitude (MA) and elasticity constants (E).
  • PCT correlated positively with reaction time (R) and time to MA (TMA), and negatively with α-Angle and coagulation index (CI).
  • Granulocytes, thrombocytes, platelet distribution width (PDW), and infection site were independent predictors of death.
  • TEG indices demonstrated high specificity but low sensitivity for predicting mortality; the thrombodynamic potential index (TPI) showed the best diagnostic value (AUC=0.609).
  • Combined TEG models with PCT/CRP showed lower efficacy than PCT alone, though TEG offered superior specificity (82.73%) when used independently.

Conclusions:

  • Granulocytes, thrombocytes, PDW, and infection site are significant independent risk factors for mortality in infected patients.
  • Individual TEG parameters possess high specificity for predicting death in infected patients, although their sensitivity is limited.
  • TEG, particularly its individual indices, offers valuable prognostic information, especially regarding specificity, in the management of infected patients.

Keywords:
coagulation functiondeathdiagnosisinfectionthromboelastography

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