危重症患儿凝血酶生成、标准凝血试验及粘弹性试验在止血评估中的相关性

Correlation between Thrombin Generation, Standard Coagulation Assays, and Viscoelastic Assays for Hemostatic Assessment in Critically Ill Children.

作者信息

Thomas Kimberly A, Shea Susan M, Saini Arun, Muszynski Jennifer A, Spinella Philip C

机构信息

Division of Critical Care Medicine, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO.

Division of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX.

出版信息

J Appl Lab Med. 2022 Sep 1;7(5):1108-1119. doi: 10.1093/jalm/jfac030.

DOI:10.1093/jalm/jfac030

PMID:35587709

Abstract

BACKGROUND

Accurate assessment of hemostatic function is essential to guide care in critically ill children with acute and acquired coagulopathies. Thrombin generation (TG) provides a global assessment of procoagulant and anticoagulant factors and is commonly used in hemostasis research laboratories. Our objective was to determine the correlation of clinically available hemostasis assays with TG in critically ill children.

METHODS

Children (<18 years old, >3 kg in weight) in the intensive care unit were enrolled from March 2016 to December 2019 in a prospective 2-center study. Coagulation tests were prothrombin time, activated thromboplastin time, anti-Xa assay, viscoelastic assays (thromboelastography [TEG], rotational thromboelastometry [ROTEM]), and TG (induced by 20 pM tissue factor in platelet poor plasma and reported as endogenous thrombin potential [ETP; nM*min]). Data are reported as median (interquartile range) or Spearman coefficient (ρ).

RESULTS

Patients (n = 106, age 10.2 years [3.8-15.3]) were divided into 3 groups: (a) no anticoagulation (n = 46), (b) anticoagulation (unfractionated heparin) without extracorporeal life support (n = 34), or (c) with extracorporeal life support (n = 26). ETP was decreased in anticoagulated compared to non-anticoagulated patients (group 1: 902.4 [560.8-1234], group 2: 315.6 [0.0-962.2], group 3: 258.5 [0.0-716.6]; P < 0.0001). Across all patients, ETP correlated best with TEG kinetic time (TEG-K), in min (ρ = -0.639), followed by TEG reaction time, in min (ρ = -0.596). By group, ETP correlated best with international normalized ratio for group 1 (ρ = -0.469), TEG-K time for group 2 (ρ = -0.640), and anti-Xa for group 3 (ρ = -0.793).

CONCLUSIONS

Standard and viscoelastic assays have varying correlation with TG in critically ill children. TEG-K time had the most consistent moderate correlation with ETP across all groups.

摘要

背景

准确评估止血功能对于指导患有急性和获得性凝血病的危重症儿童的治疗至关重要。凝血酶生成（TG）可全面评估促凝和抗凝因子，常用于止血研究实验室。我们的目的是确定危重症儿童临床可用的止血检测与TG之间的相关性。

方法

2016年3月至2019年12月，在一项前瞻性2中心研究中纳入了重症监护病房中年龄小于18岁、体重超过3 kg的儿童。凝血检测包括凝血酶原时间、活化部分凝血活酶时间、抗Xa检测、粘弹性检测（血栓弹力图[TEG]、旋转血栓弹力测定法[ROTEM]）以及TG（由20 pM组织因子在乏血小板血浆中诱导产生，并以内源性凝血酶潜能[ETP；nM*min]报告）。数据以中位数（四分位间距）或Spearman系数（ρ）报告。

结果

患者（n = 106，年龄10.2岁[3.8 - 15.3]）分为3组：（a）未抗凝（n = 46），（b）接受抗凝（普通肝素）且无体外生命支持（n = 34），或（c）接受体外生命支持（n = 26）。与未抗凝患者相比，抗凝患者的ETP降低（第1组：902.4[560.8 - 1234]，第2组：315.6[0.0 - 962.2]，第3组：258.5[0.0 - 716.6]；P < 0.0001）。在所有患者中，ETP与TEG动力学时间（TEG - K）相关性最佳，以分钟为单位（ρ = -0.639），其次是TEG反应时间，以分钟为单位（ρ = -0.596）。按组分析，ETP与第1组的国际标准化比值相关性最佳（ρ = -0.469），与第2组的TEG - K时间相关性最佳（ρ = -0.640），与第3组的抗Xa相关性最佳（ρ = -0.793）。