Relationship of thromboelastography and conventional clotting test values with severe bleeding in critically ill patients with coagulopathy: A prospective study

Abstract

Introduction This study aimed to ascertain the associations of thromboelastography (TEG®) and standard laboratory test (SLTs) values with the presence of bleeding in critically ill patients with known coagulopathy. Methods Three groups of coagulopathic patients with (a) hepatic failure, (b) postoperative period after prolonged cardiac surgery, and (c) complex abdominal surgery with sepsis were prospectively included in this study. On intensive care unit (ICU) admission, patients were stratified into two groups according to whether they had major bleeding (MB) (evident overt bleeding, important bleeding apparent on imaging studies, and/or need for moderate‐massive blood transfusion and hemodynamic instability). Blood samples were drawn for the SLTs (international normalized ratio [INR], activated partial thromboplastin time [aPTT], platelet count, and fibrinogen level [Clauss]) and TEG whole blood coagulation assays. Receiver operating characteristic (ROC) curves were generated to determine the efficiency of TEG and SLTs for detecting bleeding. The correlations between SLTs and TEG parameters with similar coagulation profiles were evaluated by Spearman rank‐order analysis. Results Eighty‐three patients were included, and bleeding was confirmed in 45 (54%). The fibrinogen level demonstrated the best accuracy for detecting bleeding with an area under the curve and 95% confidence intervals [AUC (95% CI)] of 0.74 (0.63‐0.85) with the best cutoff value of ≤ 2 g/L. Regarding TEG‐MA, the AUC (CI) obtained with the optimal cutoff value of ≤ 51 mm was 0.68 (0.56‐0.80). Conclusions Both conventional clotting tests and TEG values were poorly associated with bleeding in this critically ill cohort of patients with coagulopathy.

Predicting 30-days mortality for MIMIC-III patients with sepsis-3: a machine learning approach using XGboost

“…INR is another crucial predictive factor in the machine learning model. Several studies [43,44] found septic patients with elevated INR and platelet count appeared to have a greater risk of death compared with those without coagulopathy. There is no doubt that age and metastatic cancer as basic demographic information could be included in the model which plays unfavorable effects for the mortality.…”

Efficacy of viscoelastic hemostatic assay testing in patients with sepsis‐induced disseminated intravascular coagulation

“…Thus, R time and LY30 were determined in our analysis to be a non-significant predictor of DIC in sepsis patients. 7,11,15,17 Nevertheless, Panigada et al, 14 using a modified UK-TEG assay, revealed that LY30 was significantly increased in patients with severe sepsis-induced DIC and shock patients, and mortality was predicted by the degree of fibrinolysis impairment (OR 0.95, 95% CI, 0.93-0.98, P = .003). Significant correlations were observed between VHAs and conventional coagulation assays when used collectively to evaluate hemostasis in septic patients.…”

“…Interestingly, hypocoagulability or fibrinolysis in sepsis patients who eventually developed DIC was documented in all studies (822 patients). Hypocoagulability in sepsis patients was also found to be an independent predictor of shock, 5,7-10 DIC, 8,[11][12][13][14] hemorrhage, 15,16 organ failure, and/or mortality rate. 5,[9][10][11]14,[16][17][18][19] Few studies documented higher rates of DIC and mortality in patients who progress to a hypocoagulable state after admission.…”

“…Certain VHA parameters were also found to be strongly associated with severity of DIC such as CT in the EXTEM test. 12,20 MA (TEG) was reported to be the most frequent value that expressed a significant difference between DIC and control patients 7,10,11,[14][15][16][17]19 and independently predicted 28-day mortality (adjusted OR 4.29, P = .014). 17 Alpha angle and MCF (TEM) are useful in defining coagulopathy in sepsis-induced DIC.…”

Thromboelastography Performs Well for the Diagnosis of Periprosthetic Joint Infection.

“…Thromboelastography (TEG) is a routine test of coagulation that assesses the whole process of the clotting along time in the body [15], TEG provides a full-scale evaluation of clot formation, elasticity, and duration with measures describing various coagulation elements [16]. K-value (clotting time) re ects the rate of blood clot formation and is an indicator of brinogen function [17], Angle (α-angle) represents the clot growth rate, MA (maximum amplitude) means the maximum clot amplitude [18], A30 (amplitude at 30 min) measures clot strength at 30 minutes after MA [19], and TPI (thrombodynamic potential index) was derived from MA and K value [20]. TEG yields information about all phases of coagulation and provides further information over standard coagulation tests [16,21].…”