Categorizing Sepsis-induced Coagulopathy Using Thromboelastography: An Approach to Address the Second Pillar of...

Area of Science:

• Critical Care Medicine
• Hematology
• Sepsis Research

Background:

• Sepsis-induced coagulopathy (SIC) presents a significant challenge in patient blood management.
• Effective diagnosis and categorization of SIC are crucial for minimizing bleeding and blood loss.
• Thromboelastography (TEG) offers a potential tool for advanced SIC management.

Purpose of the Study:

• To evaluate the efficacy of thromboelastography (TEG) in diagnosing and categorizing sepsis-induced coagulopathy (SIC).
• To assess TEG's role in patient blood management, specifically in minimizing bleeding and blood loss.
• To compare outcomes of TEG-guided management versus conventional methods for SIC.

Main Methods:

• A severity-matched case-control study comparing TEG-managed SIC patients (2020-2021) with conventionally managed controls (2018-2019).
• Inclusion criteria: age > 18, SIC requiring critical care admission; severity matched using Sequential Organ Failure Assessment (SOFA) scores.
• Coagulopathy defined by abnormal coagulation screen or TEG parameters.

Main Results:

• TEG identified normal, hypo-, and hypercoagulable states in 26%, 53%, and 26% of 125 patients, respectively.
• Hypocoagulability correlated with increased SOFA scores.
• TEG-guided management reduced mortality by 58% (91.67% to 38.4%, p ≤ 0.0001) compared to controls, with hypocoagulable TEG indicating higher mortality risk (OR = 1.89).

Conclusions:

• TEG-based patient blood management in SIC differentiates hypercoagulable from hypocoagulable states.
• This differentiation provides clarity for clinical decision-making.
• Individualized management using TEG data leads to improved patient survival in SIC.