Coagulation profiles in patients with sepsis/septic shock identify mixed hypo-hypercoagulation patterns based on...

Area of Science:

• Critical Care Medicine
• Hematology
• Pathophysiology

Background:

• Sepsis frequently causes hemostatic disturbances, impacting patient outcomes.
• Conventional coagulation tests (CCTs) have limitations in detecting all coagulation abnormalities, such as hypercoagulation and hyperfibrinolysis.

Purpose of the Study:

• To characterize coagulation profiles in sepsis and septic shock using rotational thromboelastometry (ROTEM).
• To compare coagulation states between sepsis and septic shock groups, and between survivors and non-survivors.

Main Methods:

• Prospective, observational, single-center study in an ICU.
• Included 161 adult patients with sepsis or septic shock (Sepsis-3 criteria).
• Performed ROTEM and CCTs within 24 hours of ICU admission.

Main Results:

• ROTEM identified coagulation disorders in 72.7% of patients: 25.5% hypercoagulation, 54.7% hypocoagulation, 13.6% mixed patterns, 18.6% hyperfibrinolysis.
• Elevated fibrinogen and maximum clot formation (MCF)-fibtem were common and correlated (rho=0.73, p<0.05).
• Hypocoagulation was more prevalent in septic shock than sepsis; non-survivors exhibited prolonged CT-extem compared to survivors.

Conclusions:

• ROTEM effectively identifies diverse coagulation disorders in sepsis, including hypercoagulability and hyperfibrinolysis.
• Hypocoagulation is more common in septic shock, and prolonged clotting time (CT-extem) is associated with mortality.
• Findings highlight ROTEM's utility in comprehensive sepsis-related coagulation assessment.