Can rotational thromboelastometry predict septic disseminated intravascular coagulation?

Abstract

Rotational thromboelastometry (ROTEM), known as point-of-care testing, has been incorporated into various kinds of postsurgical management. However, the utility of ROTEM for rapid diagnosis of sepsis-induced disseminated intravascular coagulation (DIC) has not been investigated. This retrospective study includes 13 sepsis patients who underwent ROTEM in our emergency department in 2013. All patients were divided into two groups on the basis of the presence of DIC diagnosed by the Japanese Association for Acute Medicine (JAAM) DIC score. We evaluated the demographics, clinical characteristics, laboratory data, ROTEM test and outcomes for each patient. The correlations between JAAM DIC score and significantly different parameters by univariate analysis and receiver operating characteristic (ROC) analysis were performed to assess the accuracy of the variables. There were seven and six patients in the DIC group and non-DIC group, respectively. The DIC group showed significantly longer prothrombin times, international normalized ratio of prothrombin time and clotting times (CTs) in the EXTEM test, and higher fibrinogen and fibrin degradation products and D-dimer. The CT in EXTEM test was correlated more with JAAM DIC score (r = 0.798), than the standard coagulation test. These parameters were accurate predictors in the diagnosis of septic DIC, with an AUC of 0.952, and a cut-off value of more than 46.0 s, resulting in a sensitivity of 100.0% and a specificity of 83.3%. CT in the EXTEM test was a single reliable indicator of sepsis-induced DIC diagnosed by the JAAM DIC score, and strongly associated with severity of DIC.

Hypercoagulability and coronavirus disease 2019–associated hypoxemic respiratory failure: Mechanisms and emerging management paradigms

“…Viscoelastic testing, including thromboelastography and rotational thromboelastometry have been of benefit for predicting organ failure 45 and DIC in patients with sepsis. 46 Viscoelastic testing is now being investigated for predicting hypercoagulability in COVID-19 patients. From two studies in critically ill COVID-19 ICU patients in Italy, these patients appear to be hypercoagulable.…”

The impact of irrigating fluid absorption on blood coagulation in patients undergoing transurethral resection of the prostate

“…[26] Although PT-INR and aPTT have been known to be correlated with CT of ROTEM, [27,28] the interchangeability between the conventional coagulation test and the ROTEM analysis is still controversial. [29,30] On the other hand, it was reported that CT of EXTEM is correlated with disseminated intravascular coagulopathy by Koami et al [31] We identified the effect of irrigating fluid on the coagulation cascade more clearly by showing a strong correlation between the volume of irrigating fluid absorbed and the degree of change in the EXTEM-CT value.…”

Advance in the Management of Sepsis-Induced Coagulopathy and Disseminated Intravascular Coagulation

“…These point-of-care devices and are commonly used in trauma centers and surgical ICUs to detect coagulopathy [62]. Although their usefulness has not been tested in any large cohort of sepsis patients, good sensitivity and prognostic value have been reported in sepsis [63]. A hypercoagulability profile at admission has been reported to be helpful for the early detection of sepsis, while the degree of hypocoagulability may be associated with the severity [64].…”