声学法测量与旋转血栓弹性描记术在创伤中的比较：诊断和预后性能的比较。
Sonorheometry versus rotational thromboelastometry in trauma: a comparison of diagnostic and prognostic performance.
机构信息
Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK; Barts Health National Health Service Trust, London, UK.
Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK; Barts Health National Health Service Trust, London, UK.
出版信息
J Thromb Haemost. 2023 Aug;21(8):2114-2125. doi: 10.1016/j.jtha.2023.04.031. Epub 2023 May 8.
BACKGROUND
Rotational thromboelastometry (ROTEM) is used to rapidly identify trauma-induced coagulopathy (TIC) and direct targeted interventions in hemorrhaging trauma patients. A novel technology, Quantra System (HemoSonics), utilizes sonic estimation of elasticity via resonance sonorheometry, avoids mechanical clot interference, and may increase diagnostic accuracy, but there are limited data on bleeding in major trauma patients.
OBJECTIVES
To compare the performance of Quantra with that of ROTEM for rapid diagnosis of TIC and prediction of transfusion requirements and mortality.
METHODS
Samples were collected from adult trauma patients enrolled in a perpetual cohort study upon admission to a single level 1 trauma center between 2020 and 2021. Samples were analyzed using Quantra, ROTEM, multiple electrode aggregometry, and conventional coagulation assays.
RESULTS
Samples from 209 patients were analyzed. Correlations were strong between Quantra and ROTEM parameters (for all, p < .001): clot stiffness (CS) and tissue factor-activated ROTEM (EXTEM) clot amplitude at 5 minutes (A5) (r = 0.90); fibrinogen contribution to CS and tissue factor-activated ROTEM with cytochalasin D (FIBTEM) A5 (r = 0.85); and platelet contribution to CS and EXTEM-FIBTEM A5 (r = 0.73). Although CS showed higher discrimination than EXTEM A5 in detecting TIC (international normalized ratio, >1.2; area under the receiver operating characteristic curve, 0.83 vs 0.79; p = .038), the ability of fibrinogen contribution to CS to detect hypofibrinogenemia (a fibrinogen level of <2g/L) was good but lower than that of FIBTEM A5 (area under the receiver operating characteristic curve, 0.79 vs 0.84; p = .027). There was no difference between Quantra and ROTEM in detecting a platelet count of <150 × 10/L, predicting rapid transfusion or mortality at 6 hours.
CONCLUSION
Quantra and ROTEM have similar diagnostic performances in evaluating TIC and predicting clinically relevant outcomes. Larger studies are required to determine the utility of Quantra for goal-directed treatment of TIC.
背景
旋转血栓弹性测定仪（ROTEM）用于快速识别创伤诱导的凝血障碍（TIC）并指导出血性创伤患者的靶向干预。一种新型技术，Quantra 系统（HemoSonics），利用共振声学法对弹性进行声波估计，避免了机械凝块干扰，可能提高诊断准确性，但在严重创伤患者出血方面的数据有限。
目的
比较 Quantra 与 ROTEM 在快速诊断 TIC 以及预测输血需求和死亡率方面的性能。
方法
在 2020 年至 2021 年期间，从一家一级创伤中心连续纳入的成年创伤患者中采集样本进行一项永久性队列研究。使用 Quantra、ROTEM、多电极聚集仪和常规凝血检测分析样本。
结果
对 209 例患者的样本进行了分析。Quantra 和 ROTEM 参数之间存在强相关性（所有参数，p<0.001）：凝块硬度（CS）与组织因子激活的 ROTEM（EXTEM）5 分钟时的凝块幅度（A5）（r=0.90）；纤维蛋白原对 CS 的贡献与细胞松弛素 D 激活的 ROTEM（FIBTEM）A5（r=0.85）；血小板对 CS 的贡献与 EXTEM-FIBTEM A5（r=0.73）。虽然 CS 在检测 TIC 时比 EXTEM A5 具有更高的区分能力（国际标准化比值>1.2；接受者操作特征曲线下面积，0.83 与 0.79；p=0.038），但 CS 中纤维蛋白原贡献检测低纤维蛋白原血症（纤维蛋白原水平<2g/L）的能力良好，但低于 FIBTEM A5（接受者操作特征曲线下面积，0.79 与 0.84；p=0.027）。Quantra 和 ROTEM 在检测血小板计数<150×10/L、预测 6 小时内快速输血或死亡率方面无差异。
结论
Quantra 和 ROTEM 在评估 TIC 和预测临床相关结局方面具有相似的诊断性能。需要更大的研究来确定 Quantra 在 TIC 目标导向治疗中的效用。
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