Thromboelastograph:A prognostic marker in sepsis with organ dysfunction without overt bleeding
Autor: | Maria Koshy, Ronald Albert Benton Carey, Sukesh C. Nair, Tulasi Geevar, Ramya Iyadurai, John Victor Peter, Fibi Ninan K, Ravikar Ralph, Justin K. Varghese, Bijesh Yadav, Mohammad Sadiq J |
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Rok vydání: | 2021 |
Předmět: |
Male
medicine.medical_specialty Multiple Organ Failure Critical Care and Intensive Care Medicine Gastroenterology Sepsis 03 medical and health sciences 0302 clinical medicine Internal medicine Coagulopathy medicine Humans Prospective Studies Prospective cohort study business.industry Organ dysfunction 030208 emergency & critical care medicine Blood Coagulation Disorders Middle Aged Prognosis medicine.disease Thrombelastography Pneumonia 030228 respiratory system Cohort Mann–Whitney U test SOFA score medicine.symptom business |
Zdroj: | Journal of Critical Care. 65:177-183 |
ISSN: | 0883-9441 |
Popis: | Background Coagulation abnormalities are not infrequent in sepsis. It is unclear if abnormalities in thromboelastogram (TEG) are associated with mortality in patients with severe sepsis without overt bleeding. Materials and methods In this prospective study, patients were categorised as those with normal coagulation, hypercoagulable or hypercoagulable state based on admission TEG parameters (R time, K time, Maximum amplitude (MA), α angle). Their association with mortality was explored using Fisher's exact and Mann-Whitney U test as appropriate. Results The study cohort (n = 87; 49 male) with median (IQR) age 51 (42–60) years and admission SOFA score 8 (6–11) included scrub typhus (24.1%), pneumonia (22.6%) and urosepsis (10.3%). Non-invasive and invasive ventilation and vasopressors were required in 28.1%, 68.9% and 74%, respectively. Mortality was 24.1%. Based on R time, K time and α angle, 3.5% to 9.3% had a hypercoagulable state and 26.7 to 29.9% were hypocoagulable. Prolonged R time (p = 0.04) and reduced alpha angle (p = 0.01) in patients with hypocoagulable state was associated with mortality. K time, α angle and MA were significantly different in patients requiring transfusion (p Conclusion A subset of patients with severe sepsis without overt bleeding are hypocoagulable. Hypocoagulability is associated with mortality and need for transfusion. |
Databáze: | OpenAIRE |
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