TEG in the monitoring of coagulation changes in patients with sepsis and the clinical significance

Zhou,Wenyan; Zhou,Wenjie; Bai,Jijia; Ma,Shenmao; Liu,Qinfu; Ma,Xigang

doi:10.3892/etm.2019.7342

TEG in the monitoring of coagulation changes in patients with sepsis and the clinical significance

Authors:
- Wenyan Zhou
- Wenjie Zhou
- Jijia Bai
- Shenmao Ma
- Qinfu Liu
- Xigang Ma
View Affiliations

Affiliations: Department of Intensive Care Unit, General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750004, P.R. China, Resident Standardized Training Base, General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750004, P.R. China
Published online on: March 5, 2019 https://doi.org/10.3892/etm.2019.7342
Pages: 3373-3382
Copyright: © Zhou et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Application values of thromboelastography (TEG) in dynamic monitoring of coagulation parameters of sepsis patients were investigated. Eighty-one patients with sepsis who were admitted to the ICU department of the General Hospital of Ningxia Medical University from April 1, 2015 to December 31, 2015 were collected. Clinical data of the patients were collected. Data were compared using 5 grouping methods: i) the 81 patients were divided into the sepsis group (n=45) and sepsis shock group (n=36); ii) patients were divided into two groups: group A (APACHE II score ≤13, n=51); group B (APACHE II score >13, n=30); iii) according to Disseminated Intravascular Coagulation Diagnosis Integral System (CDSS), patients were divided into non-disseminated intravascular coagulation (DIC) group (CDSS <7 points) and DIC group (CDSS ≥7 points); TEG indexes were compared between the two groups; iv) correlation between TEG indexes and Sequential Organ Failure Assessment (SOFA) scores was analyzed; v) patients were divided into survival group and non-survival group and correlations between TEG indicators and prognosis were analyzed. At 6 h after ICU entry, compared with sepsis group, R value and K time were significantly increased, LY30 was also increased, while MA value, coagulation index (CI), and α angle were significantly decreased in the septic shock group (P<0.05). At 6 h after ICU entry, compared with sepsis group, R value and K time were significantly increased, while MA value, CI, and α angle were significantly decreased in the septic shock group (P<0.05). Compared with the non-DIC group, the DIC group had prolonged K time, decreased α angle, increased R value, and decreased CI and MA value (P<0.05). With increase of SOFA scores, R value and K value increased significantly, and α angle, MA value, and CI decreased significantly (P<0.05). According to TEG, platelet function and fibrinogen function of DIC patients were significantly reduced, and the body showed hypocoagulability.

View Figures

View References

1	Azkárate I, Sebastián R, Cabarcos E, Choperena G, Pascal M and Salas E: A prospective, observational severe sepsis/septic shock registry in a tertiary hospital in the province of Guipuzcoa (Spain). Med Intensiva. 36:250–256. 2012.(In Spanish). View Article : Google Scholar : PubMed/NCBI
2	Samuels JM, Moore HB and Moore EE: Coagulopathy in severe sepsis: Interconnectivity of coagulation and the immune system. Surg Infect (Larchmt). 19:208–215. 2018. View Article : Google Scholar : PubMed/NCBI
3	Wang Y, Ouyang Y, Liu B, Ma X and Ding R: Platelet activation and antiplatelet therapy in sepsis: A narrative review. Thromb Res. 166:28–36. 2018. View Article : Google Scholar : PubMed/NCBI
4	Wang Y, Wang D, Fu J and Liu Y: Predictive value of SOFA, qSOFA score and traditional evaluation index on sepsis prognosis. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 29:700–704. 2017.(In Chinese). PubMed/NCBI
5	Wang L, Bastarache JA and Ware LB: The coagulation cascade in sepsis. Curr Pharm Des. 14:1860–1869. 2008. View Article : Google Scholar : PubMed/NCBI
6	Reikvam H, Steien E, Hauge B, Liseth K, Hagen KG, Størkson R and Hervig T: Thrombelastography. Transfus Apheresis Sci. 40:119–123. 2009. View Article : Google Scholar
7	Kozek-Langenecker S: Management of massive operative blood loss. Minerva Anestesiol. 73:401–415. 2007.PubMed/NCBI
8	Salooja N and Perry DJ: Thrombelastography. Blood Coagul Fibrinolysis. 12:327–337. 2001. View Article : Google Scholar : PubMed/NCBI
9	Kunio NR, Differding JA, Watson KM, Stucke RS and Schreiber MA: Thrombelastography-identified coagulopathy is associated with increased morbidity and mortality after traumatic brain injury. Am J Surg. 203:584–588. 2012. View Article : Google Scholar : PubMed/NCBI
10	Ren J, Zhao Y, Yuan Y, Han G, Li W, Huang Q, Tong Z and Li J: Complement depletion deteriorates clinical outcomes of severe abdominal sepsis: A conspirator of infection and coagulopathy in crime? PLoS One. 7:e470952012. View Article : Google Scholar : PubMed/NCBI
11	Sivula M, Pettilä V, Niemi TT, Varpula M and Kuitunen AH: Thromboelastometry in patients with severe sepsis and disseminated intravascular coagulation. Blood Coagul Fibrinolysis. 20:419–426. 2009. View Article : Google Scholar : PubMed/NCBI
12	Ostrowski SR, Windeløv NA, Ibsen M, Haase N, Perner A and Johansson PI: Consecutive thrombelastography clot strength profiles in patients with severe sepsis and their association with 28-day mortality: A prospective study. J Crit Care. 28:317.e1–317.e11. 2013. View Article : Google Scholar
13	Haase N, Ostrowski SR, Wetterslev J, Lange T, Møller MH, Tousi H, Steensen M, Pott F, Søe-Jensen P, Nielsen J, et al: Thromboelastography in patients with severe sepsis: A prospective cohort study. Intensive Care Med. 41:77–85. 2015. View Article : Google Scholar : PubMed/NCBI
14	Braber A and van Zanten AR: Unravelling post-ICU mortality: Predictors and causes of death. Eur J Anaesthesiol. 27:486–490. 2010. View Article : Google Scholar : PubMed/NCBI
15	Namendys-Silva SA, Texcocano-Becerra J and Herrera-Gómez A: Prognostic factors in critically ill patients with solid tumours admitted to an oncological intensive care unit. Anaesth Intensive Care. 38:317–324. 2010.PubMed/NCBI
16	Jianmin Q, Xueliang Y, Liqin L, Yongsheng W, Licang H and Yuanxin H: Value of continuous video EEG and EEG responses to thermesthesia stimulation in prognosis evaluation of comatose patients after cardiopulmonary resuscitation. Open Med (Wars). 13:35–40. 2018. View Article : Google Scholar : PubMed/NCBI
17	Singh RK, Poddar B, Baronia AK, Azim A, Gurjar M, Singhal S, Srivastava S and Saigal S: Audit of patients with severe acute pancreatitis admitted to an intensive care unit. Indian J Gastroenterol. 31:243–252. 2012. View Article : Google Scholar : PubMed/NCBI
18	Qiao Q, Lu G, Li M, Shen Y and Xu D: Prediction of outcome in critically ill elderly patients using APACHE II and SOFA scores. J Int Med Res. 40:1114–1121. 2012. View Article : Google Scholar : PubMed/NCBI
19	Goulden R, Hoyle MC, Monis J, Railton D, Riley V, Martin P, Martina R and Nsutebu E: qSOFA, SIRS and NEWS for predicting inhospital mortality and ICU admission in emergency admissions treated as sepsis. Emerg Med J. 35:345–349. 2018. View Article : Google Scholar : PubMed/NCBI
20	Mato A, Fuchs BD, Heitjan DF, Mick R, Halpern SD, Shah PD, Jacobs S, Olson EM, Schuster SJ, Ujjani C, et al: Utility of the systemic inflammatory response syndrome (SIRS) criteria in predicting the onset of septic shock in hospitalized patients with hematologic malignancies. Cancer Biol Ther. 8:1095–1100. 2009. View Article : Google Scholar : PubMed/NCBI
21	Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, Kumar A, Sevransky JE, Sprung CL, Nunnally ME, et al: Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Crit Care Med. 45:486–552. 2017. View Article : Google Scholar : PubMed/NCBI
22	Knoebl P: Blood coagulation disorders in septic patients. Wien Med Wochenschr. 160:129–138. 2010. View Article : Google Scholar : PubMed/NCBI
23	Levi M and Schultz M: The inflammation-coagulation axis as an important intermediate pathway in acute lung injury. Crit Care. 12:144–147. 2008. View Article : Google Scholar : PubMed/NCBI
24	Lissalde-Lavigne G, Combescure C, Muller L, Bengler C, Raillard A, Lefrant JY and Gris JC: Simple coagulation tests improve survival prediction in patients with septic shock. J Thromb Haemost. 6:645–653. 2008. View Article : Google Scholar : PubMed/NCBI
25	Luddington RJ: Thrombelastography/thromboelastometry. Clin Lab Haematol. 27:81–90. 2005. View Article : Google Scholar : PubMed/NCBI
26	Nakae H, Endo S, Inada K, Takakuwa T, Kasai T and Yoshida M: Relationship between thromboxane B2 and 6-keto-prostaglandin F1 alpha in sepsis. Res Commun Chem Pathol Pharmacol. 83:297–302. 1994.PubMed/NCBI
27	Alarcón G, Fardella P, Conte G, Vargas V, Parada X and Cuneo M: Changes in coagulation in patients with sepsis. Rev Med Chil. 121:537–541. 1993.(In Spanish). PubMed/NCBI
28	Wang H, Li Z, Yin M, Chen XM, Ding SF, Li C, Zhai Q, Li Y, Liu H and Wu DW: Combination of Acute Physiology and Chronic Health Evaluation II score, early lactate area, and N-terminal prohormone of brain natriuretic peptide levels as a predictor of mortality in geriatric patients with septic shock. J Crit Care. 30:304–309. 2015. View Article : Google Scholar : PubMed/NCBI
29	Chen FG and Koh KF: Septic shock in a surgical intensive care - validation of multiorgan and APACHE II scores in predicting outcome. Ann Acad Med Singapore. 23:447–451. 1994.PubMed/NCBI
30	Levi M and Scully M: How I treat disseminated intravascular coagulation. Blood. 131:845–854. 2018. View Article : Google Scholar : PubMed/NCBI
31	Di Nisio M, Baudo F, Cosmi B, D'Angelo A, De Gasperi A, Malato A, Schiavoni M and Squizzato A; Italian Society for Thrombosis and Haemostasis, : Diagnosis and treatment of disseminated intravascular coagulation: Guidelines of the Italian Society for Haemostasis and Thrombosis (SISET). Thromb Res. 129:e177–e184. 2012. View Article : Google Scholar : PubMed/NCBI
32	Louw SJ, Mayne ALH and Mayne ES: Evaluation of the diagnostic utility of individual parameters in the disseminated intravascular coagulation (DIC) panel for use in under resourced settings. Int J Lab Hematol. 40:e46–e48. 2018. View Article : Google Scholar : PubMed/NCBI
33	Masuda T, Shoko T and Deguchi Y: Clinical investigation of coagulation markers for early detection of sepsis-induced disseminated intravascular coagulation: A single-center, prospective observational study. Clin Appl Thromb Hemost. 24:1082–1087. 2018. View Article : Google Scholar : PubMed/NCBI
34	Dorman BH, Spinale FG, Bailey MK, Kratz JM and Roy RC: Identification of patients at risk for excessive blood loss during coronary artery bypass surgery: Thromboelastography versus coagulation screen. Anesth Analg. 76:694–700. 1993. View Article : Google Scholar : PubMed/NCBI
35	Rocha LL, Pessoa CM, Neto AS, do Prado RR, Silva E, de Almeida MD and Correa TD; POCKET Trial Investigators, : Thromboelastometry versus standard coagulation tests versus restrictive protocol to guide blood transfusion prior to central venous catheterization in cirrhosis: Study protocol for a randomized controlled trial. Trials. 18:852017. View Article : Google Scholar : PubMed/NCBI
36	Bowbrick VA, Mikhailidis DP and Stansby G: Influence of platelet count and activity on thromboelastography parameters. Platelets. 14:219–224. 2003. View Article : Google Scholar : PubMed/NCBI