Role of Thromboelastography as an Early Predictor of Disseminated Intravascular Coagulation in Patients with Septic Shock

Abstract

(1) Background: The currently proposed criteria for diagnosing overt disseminated intravascular coagulation (DIC) are not suitable for early detection of DIC. Thromboelastography (TEG) rapidly provides a comprehensive assessment of the entire coagulation process and is helpful as a guide for correcting consumptive coagulopathy in sepsis-induced DIC. This study aimed to investigate the role of TEG in the prediction of DIC in patients with septic shock. (2) Methods: TEG was conducted prospectively in 1294 patients with septic shock at the emergency department (ED) between January 2016 and December 2019. After exclusion of 405 patients with “do not attempt resuscitation” orders, those refusing enrollment, and those developing septic shock after ED presentation, 889 patients were included. DIC was defined as an International Society on Thrombosis and Hemostasis score ≥ 5 points within 24 h. (3) Results: Of the 889 patients with septic shock (mean age 65.6 ± 12.7 years, 58.6% male), 158 (17.8%) developed DIC. TEG values, except lysis after 30 min, were significantly different between the DIC and non-DIC groups. Among the TEG values, the maximal amplitude (MA) had the highest discriminating power for DIC, with an area under the curve of 0.814. An MA < 60 indicated DIC with 79% sensitivity, 73% specificity, and 94% negative predictive value. Based on multivariable analysis, MA < 60 was an independent predictor of DIC (odds ratio 5.616 (95% confidence interval: 3.213–9.818)). (4) Conclusions: In patients with septic shock, the MA value in TEG could be a valuable tool for early prediction of DIC.

Hypercoagulation detected by routine and global laboratory hemostasis assays in patients with infective endocarditis

“…At admission, coagulation parameters in all patients were shifted towards hypercoagulation as a consequence of inflammation which was expressed in rise of fibrinogen ( Fig 1 ), increase of MA in thromboelastography ( Fig 3 ), increase in Vi, V and D in thrombodynamics ( Fig 4 ). In some patients we observed signs of consumption coagulopathy [ 24 , 35 , 36 ] expressed in decrease in prothrombin ( Fig 1 ) and presence of decreased values of R, K and α in TEG ( Fig 3 ) and Vi and V in thrombodynamics in the absence of antithrombotic therapy. An increase in the concentration of D-dimers in patients compared with healthy volunteers also indicates the presence of active clotting and subsequent lysis of the formed clots ( Fig 1 ).…”

Neonatal Sepsis and Hemostasis

“…They are applied to detect hyperfibrinolysis and guide the management of bleeding with targeted blood products in trauma coagulopathy [ 57 ]. Fibrinolysis is also disrupted primarily in severely septic patients with developed DIC and is strongly correlated with increased morbidity and mortality in severe sepsis and septic shock [ 58 , 59 ]. The essence of thromboelastic testing in patients presenting with hemorrhage has been recently described by a Cochrane review that encompassed 17 trials, two of which included children.…”

Special Issue on “Disseminated Intravascular Coagulation: Current Understanding and Future Perspectives”

“…Kim et al investigated the role of thromboelastography (TEG) as an early predictor of DIC in patients with septic shock [ 11 ]. They included 889 patients (158 with DIC, 731 without DIC) who underwent TEG in the emergency department.…”