Coagulation abnormalities identified by thromboelastometry in patients with severe sepsis

Abstract

The aim of this study was to monitor the development of coagulation abnormalities in patients with severe sepsis using thromboelastometry and to assess whether increased endotoxin activity was associated with a change in coagulation. Data collected on ICU admission, day 2, 3, and 4 were analysed in 61 patients. Thromboelastometry made it possible to identify patients with a normal (group 1), hypercoagulable (group 2), or hypocoagulable (group 3) pattern. The best accuracy of thromboelastometry parameters as potential indices of coagulation abnormalities was yielded by the clot formation time and maximum clot firmness. The mortality rate was low in group 1(16%) and the presence of abnormalities, indicating either a hyper or hypocoagulation pattern, was associated with significantly higher mortality (42 and 39% respectively; P = 0.05). In group 1, baseline endotoxin activity was low [0.22 endotoxin activity units (EAU), 0.15-0.43] and did not change significantly during the observation period. In group 2, baseline endotoxin activity was elevated (0.52 EAU (0.39-0.62)) and remained high on day 2, 3, and 4. In group 3, baseline endotoxin activity was elevated (0.56 EAU (0.28-0.80)) and similarly to group 2, remained high on day 2, 3, and 4. The presence of coagulation disorders indicates a high-risk subpopulation of critically ill patients as reflected in significantly higher mortality rates and increased endotoxin activity.

Review: The Emerging Role of Neutrophil Extracellular Traps in Sepsis and Sepsis-Associated Thrombosis

“…However, an excessive activation of the coagulation system along with vascular endothelial damage will cause the formation of microvascular thrombus and lead to multiorgan dysfunction ( Gando, 2010 ). An hyperactivated and dysfunctional coagulation system will also manifest as consumption of anticoagulant factors, inhibition of the fibrinolytic system, significant shortening of clot formation kinetics (CFT), and increase clot firmness (CF) ( Adamik et al., 2017 ). As a pro-inflammatory mediator, thrombin, a critical mediator of the coagulation cascade in sepsis, can activate receptors through specific proteases to stimulate monocytes and endothelial cells (ECs).…”

Plasma and Cellular Forms of Fibronectin as Prognostic Markers in Sepsis

“…As a consequence, septic shock and multiorgan dysfunction syndrome develop [3]. Our previous studies showed that coagulation abnormalities are present in a majority of patients with sepsis and are associated with a significantly higher mortality rate [4]. There is a pressing need for early, sensitive, and specific biomarkers that would indicate the presence of sepsis and could be used to monitor the severity of sepsis during treatment in the intensive care unit.…”

Whole-blood hypocoagulable profile correlates with a greater risk of death within 28 days in patients with severe sepsis

“…Some reports have indicated that alterations in hemostasis and blood coagulation may occur as early as 60 minutes after induction of endotoxemia. Sepsis-induced coagulopathies have been linked to higher endotoxin activity, increased release of biomarkers of endothelial injury, meaningful changes in the coagulation process, and higher mortality risk [25][26][27]. Specifically, CFT has been previously described as the most sensitive tool for the rapid detection of hypocoagulability though no differences between short and long-term mortality have been demonstrated to date [25].…”

“…Sepsis-induced coagulopathies have been linked to higher endotoxin activity, increased release of biomarkers of endothelial injury, meaningful changes in the coagulation process, and higher mortality risk [25][26][27]. Specifically, CFT has been previously described as the most sensitive tool for the rapid detection of hypocoagulability though no differences between short and long-term mortality have been demonstrated to date [25]. Moreover, CFT relies on clotting factors and platelet function [18] and it is well established that thrombocytopenia is an important predictor of ICU mortality [28].…”