Scărlătescu Ecaterina, Lancé Marcus D, White Nathan J, 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 Sep;29(6):533-539. doi: 10.1097/MBC.0000000000000757.
: Sepsis induces alterations in blood coagulation which are associated with mortality. Using rotational thromboelastometry (ROTEM), these states are often characterized by changes in parameters representing terminal clot lysis. However, the ROTEM changes are often subtle, making them difficult to recognize and interpret. The objective of this study is to evaluate a new ROTEM clot velocity parameter representing clot formation kinetics in septic ICU patients. We hypothesized that this time-based parameter was significantly different in critically ill septic survivors vs. nonsurvivors. This retrospective observational study included severe sepsis and septic shock patients having a minimum of two organ dysfunctions by Sequential Organ Failure Assessment criteria (study group), and a control group of healthy adults without infection . ROTEM with EXTEM activation was performed in all groups. The time from maximal clot formation velocity to zero velocity, representing the latter portion of time during active clot formation prior to achieving maximal clot firmness (t-AUCi) was calculated along with other ROTEM parameters and compared between septic survivors, nonsurvivors and healthy controls. A total of 76 septic patients, of which 26.3%, survived, were included in the study group, and 26 healthy control individuals were included in the control group. t-AUCi correlated with terminal clot lysis (P < 0.001), and was significantly prolonged in septic nonsurvivors compared with survivors and healthy controls (P < 0.001). t-AUCi also differentiated nonsurvivors vs. survivors among those patients having similar ROTEM lysis indices. t-AUCi was useful to differentiate critically ill septic patients, and could be useful to identify septic patients with high-risk of ICU mortality.
脓毒症会引发血液凝固的改变，而这与死亡率相关。使用旋转血栓弹力图（ROTEM），这些状态通常以代表终末血块溶解的参数变化为特征。然而，ROTEM的变化往往很细微，难以识别和解读。本研究的目的是评估一个新的ROTEM血块速度参数，该参数代表脓毒症重症监护病房（ICU）患者的血块形成动力学。我们假设这个基于时间的参数在重症脓毒症幸存者与非幸存者之间存在显著差异。这项回顾性观察性研究纳入了根据序贯器官衰竭评估标准至少有两个器官功能障碍的严重脓毒症和脓毒性休克患者（研究组），以及无感染的健康成年对照组。所有组均进行了EXTEM激活的ROTEM检测。计算从最大血块形成速度到零速度的时间，即达到最大血块硬度之前活跃血块形成过程中后段时间（t-AUCi），并与其他ROTEM参数一起在脓毒症幸存者、非幸存者和健康对照组之间进行比较。研究组共纳入76例脓毒症患者，其中26.3%存活，对照组纳入26名健康个体。t-AUCi与终末血块溶解相关（P<0.001），与幸存者和健康对照组相比，脓毒症非幸存者的t-AUCi显著延长（P<0.001）。在具有相似ROTEM溶解指数的患者中，t-AUCi也能区分非幸存者和幸存者。t-AUCi有助于区分重症脓毒症患者，可能有助于识别有ICU死亡高风险的脓毒症患者。
