Scărlătescu Ecaterina, Lancé Marcus D, White Nathan J, Aramă Stefan S, Tomescu Dana R
Department of Anaesthesia and Intensive Care, Fundeni Clinical Institute, Bucharest, Romania.
Department of Anesthesiology, ICU and Perioperative Medicine, Hamad Medical Corporation, Doha, Qatar.
Blood Coagul Fibrinolysis. 2018 Jan;29(1):92-96. doi: 10.1097/MBC.0000000000000680.
: The objectives of the study are to examine the effect of sepsis on the coagulation profile of patients having solid cancer and to test the hypothesis that septic patients with cancer have normal or increased hemostatic capacity despite prolonged standard coagulation tests (SCTs) compared with noninfected cancer patients. Patients with solid cancer were included in the study forming two groups: study group included patients with sepsis with minimum two organ dysfunctions and control group formed by noninfected cancer patients. SCTs, platelet count, plasma levels of coagulation factors and rotation thromboelastometry (TEM International GmbH, Munich, Germany) were determined in both groups. Study group patients (n = 35) showed prolonged SCTs, thrombocytopenia, decreased coagulation factor levels and increased D-dimer compared with control group (n = 35). However, fibrinogen levels and clot firmness assessed by rotation thromboelastometry were not different between groups and clot lysis indexes at 45 and 60 min were increased in study group compared with control group. The first derivative of the clot firmness curve revealed an increased time to the maximum velocity of clot formation for study group, without differences in the maximum velocity of clot formation, or in total thrombus formation. Sepsis with organ dysfunction in cancer patients is associated with delayed initiation of coagulation and reduced fibrinolysis compared with control patients, but overall clot formation and stabilization is not different. For septic cancer patients, SCTs and plasmatic indicators of fibrinolysis do not translate well to whole blood clot formation and may be misleading indicators of thrombotic or bleeding risk.
本研究的目的是检验脓毒症对实体癌患者凝血指标的影响，并验证以下假设：与未感染的癌症患者相比，患有癌症的脓毒症患者尽管标准凝血试验（SCT）时间延长，但仍具有正常或增强的止血能力。实体癌患者被纳入研究并分为两组：研究组包括至少有两个器官功能障碍的脓毒症患者，对照组由未感染的癌症患者组成。两组均测定了SCT、血小板计数、凝血因子血浆水平以及旋转血栓弹力图（德国慕尼黑TEM International GmbH公司）。与对照组（n = 35）相比，研究组患者（n = 35）的SCT时间延长、血小板减少、凝血因子水平降低且D - 二聚体升高。然而，通过旋转血栓弹力图评估的纤维蛋白原水平和血凝块硬度在两组之间并无差异，与对照组相比，研究组在45分钟和60分钟时的血凝块溶解指数升高。血凝块硬度曲线的一阶导数显示，研究组达到血凝块形成最大速度的时间增加，而血凝块形成的最大速度或总血栓形成并无差异。与对照患者相比，癌症患者伴有器官功能障碍的脓毒症与凝血启动延迟和纤维蛋白溶解减少有关，但总体血凝块形成和稳定并无差异。对于脓毒症癌症患者，SCT和纤维蛋白溶解的血浆指标并不能很好地反映全血血凝块形成情况，可能会误导血栓形成或出血风险的评估。
