Sang Min Kim1, Sang-Il Kim2, Gina Yu3, June-Sung Kim1, Seok In Hong1, Bora Chae1, Yo Sep Shin1, Youn Jung Kim1, Seongsoo Jang4, Won Young Kim1. 1. Department of Emergency Medicine, Ulsan University College of Medicine, Asan Medical Center, Seoul 05505, Korea. 2. Department of Emergency Medicine, Soonchunhyang University Seoul Hospital, Seoul 04401, Korea. 3. Department of Emergency Medicine, University of Yonsei College of Medicine, Seoul 06273, Korea. 4. Department of Laboratory Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea.
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.
(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.
Authors: Ekaterina M Koltsova; Maria A Sorokina; Alexandra S Pisaryuk; Nikita M Povalyaev; Anastasia A Ignatova; Dmitry M Polokhov; Elizaveta O Kotova; Alexander V Balatskiy; Fazoil I Ataullakhanov; Mikhail A Panteleev; Zhanna D Kobalava; Anna N Balandina Journal: PLoS One Date: 2021-12-15 Impact factor: 3.240