Critical Care Unit, University Hospital "Virgen del Rocío", Seville, Spain.
Pharmacia division, University Hospital "Virgen del Rocío", Seville, Spain.
Int J Lab Hematol. 2019 Oct;41(5):671-678. doi: 10.1111/ijlh.13086. Epub 2019 Aug 12.
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.
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.
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).
Both conventional clotting tests and TEG values were poorly associated with bleeding in this critically ill cohort of patients with coagulopathy.
本研究旨在确定血栓弹力图（TEG）和标准实验室检查（SLTs）值与已知凝血障碍的危重病患者出血之间的关系。
本前瞻性研究纳入了三组凝血障碍患者：（a）肝功能衰竭；（b）心脏手术后延长期间；（c）伴脓毒症的复杂腹部手术。在入住重症监护病房（ICU）时，根据是否有大出血（MB）（明显显性出血、影像学检查显示重要出血、和/或需要中大量输血和血流动力学不稳定）将患者分为两组。采集血液样本进行 SLTs（国际标准化比值[INR]、活化部分凝血活酶时间[aPTT]、血小板计数和纤维蛋白原水平[Clauss]）和 TEG 全血凝血检测。生成接受者操作特征（ROC）曲线以确定 TEG 和 SLTs 检测出血的效率。通过 Spearman 等级相关分析评估具有相似凝血特征的 SLTs 和 TEG 参数之间的相关性。
共纳入 83 例患者，45 例（54%）证实有出血。纤维蛋白原水平的曲线下面积和 95%置信区间（AUC（95%CI））为 0.74（0.63-0.85），最佳截断值≤2g/L，对检测出血的准确性最高。对于 TEG-MA，最佳截断值≤51mm 时的 AUC（CI）为 0.68（0.56-0.80）。
在该凝血障碍危重病患者队列中，常规凝血试验和 TEG 值与出血的相关性均较差。
