Rotational Thromboelastometric Profile in Early Sepsis: A Prospective Cohort Study

Area of Science:

• Critical Care Medicine
• Hematology
• Infectious Diseases

Background:

• Coagulation abnormalities are frequent in sepsis and linked to higher mortality.
• Early identification of hemostatic derangements is crucial for sepsis management.

Purpose of the Study:

• To evaluate the hemostatic profile of sepsis patients using ROTEM.
• To identify ROTEM parameters that best predict short-term mortality in sepsis.

Main Methods:

• Prospective analysis of consecutive sepsis patients in intensive care.
• Inclusion criteria: sepsis diagnosis and pro-calcitonin >0.5 ng/mL.
• Collected clinical, laboratory, and ROTEM data.

Main Results:

• The study included 78 patients (49% male) with a median SOFA score of 8.
• Abnormal ROTEM parameters included clotting time, clot amplitude, and maximal clot firmness, indicating fibrinogen involvement.
• 28% of patients died in the ICU; ROTEM parameters related to fibrinolysis differed between survivors and non-survivors.

Conclusions:

• ROTEM analysis in early sepsis shows enhanced coagulation, primarily via fibrinogen.
• While fibrinolytic activity was slightly lower in non-survivors, it remained within reference ranges.
• A predictive model incorporating extrinsic coagulation and fibrinolytic parameters showed the highest predictive value for mortality.