Kamal Manoj, Hariprasad R, Bhatia Pradeep K, Misra Sanjeev, Sharma Praveen, Garg Mahendra K, Kothari Nikhil, Gupta Manoj, Singariya Geeta
Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
Department of Surgical Oncology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
J Anaesthesiol Clin Pharmacol. 2022 Jul;38(Suppl 1):S89-S95. doi: 10.4103/joacp.joacp_469_21. Epub 2022 Jun 15.
The hypercoagulability occurring in COVID-19 patients is detected only by Rotational thromboelastometry (ROTEM). However, the benefit of performing ROTEM in the management of disease and predicting the outcome of COVID-19 patients is yet to be established.
The data of 23 critically ill and 11 stable COVID-19 adult patients were extracted from the hospital information system admitted between July and August 2020 and patient charts and analyzed retrospectively. The critically ill patients were divided as a survivor and non-survivor groups. The Intrinsic pathway part of ROTEM (INTEM) and Fibrinogen part of ROTEM (FIBTEM) were performed on day 0 for both critically ill and stable patients, and on day 10 for critically ill patients. The statistical package for social science (SPSS) version 26 was used for statistical analysis.
The median FIBTEM amplitude at 5 min (A5) and maximum clot firmness (MCF) were elevated in both stable and critically ill patients (24 vs 27 mm, P = 0.46 and 27.5 vs 40 mm, P = 0.011) with a significant difference in FIBTEM MCF. But there was no significant difference between number of survivors and non-survivors with FIBTEM MCF >25 at day 0 and day 10.
The Hypercoagulability state as detected by ROTEM parameters at day 0 and day 10 had no association with the outcome (mortality) of critically ill COVID-19 patients. Hence it cannot be used as a prognostic test. The increasing age, comorbidities and D-dimer values were associated with a poor prognosis in COVID-19 patients.
新型冠状病毒肺炎（COVID-19）患者出现的高凝状态仅通过旋转血栓弹力图（ROTEM）检测。然而，在COVID-19患者的疾病管理和预后预测中进行ROTEM检测的益处尚未明确。
从2020年7月至8月收治的医院信息系统中提取23例危重症和11例稳定型COVID-19成年患者的数据，并回顾性分析患者病历。危重症患者分为存活组和非存活组。对危重症和稳定型患者在第0天进行ROTEM的内源性途径部分（INTEM）和ROTEM的纤维蛋白原部分（FIBTEM）检测，对危重症患者在第10天进行检测。使用社会科学统计软件包（SPSS）26版进行统计分析。
稳定型和危重症患者的FIBTEM在5分钟时的振幅中位数（A5）和最大血凝块硬度（MCF）均升高（分别为24 vs 27 mm，P = 0.46；27.5 vs 40 mm，P = 0.011），FIBTEM MCF有显著差异。但在第0天和第10天，FIBTEM MCF>25的存活者和非存活者数量之间无显著差异。
第0天和第10天通过ROTEM参数检测到的高凝状态与危重症COVID-19患者的预后（死亡率）无关。因此，它不能用作预后检测指标。年龄增加、合并症和D-二聚体值与COVID-19患者的不良预后相关。
