Mohapatra Priyanka, Kumar Arvind, Singh Rakesh Kumar, Gupta Ruchi, Hussain Mumtaz, Singh Swati, Kumar Pankaj
Department of Anesthesiology & Critical Care Medicine, Indira Gandhi Institute of Medical Science, Patna, Bihar, India.
Department of Critical Care, Holy Family Hospital, New Delhi, India.
Indian J Crit Care Med. 2023 Sep;27(9):625-634. doi: 10.5005/jp-journals-10071-24539.
Sepsis is associated with wide variable coagulation abnormalities. Thromboelastography (TEG) effectively measures the viscoelastic properties of the clots. This study aims to illustrate the viscoelastic properties of clot quality and mass in sepsis and septic shock patients using TEG, as an effective tool over standard coagulation tests.
A single-center, prospective observational study was conducted. 50 patients each meeting the criteria for sepsis and septic shock, and a healthy group of 30 patients was included in the study. Blood samples were obtained and analyzed for standard coagulation tests, platelet count, fibrinogen, and TEG study.
A total of 130 patients were included. Septic shock patients had a higher sequential (sepsis-related) organ failure score. Prothrombin time (PT) and activated partial thromboplastin time (aPTT) were increased significantly as compared to the sepsis and control groups. TEG markers such as alpha angle, and maximum amplitude (MA) were significantly prolonged while reaction time (R time), was significantly shortened in the sepsis group as compared to the healthy group, suggestive of a hypercoagulable state in sepsis patients. While in septic shock patients, MA and Lysis Index 30 (LY 30) were significantly prolonged and, R time was significantly shortened compared to all other groups. Even though LY30 in sepsis patients was found to be within the normal range ( < 0.001), 18% of patients had prolonged LY30 indicating a hypercoagulable state with impaired fibrinolysis.
Thromboelastography, as a point-of-care test combined with conventional coagulation tests can provide additional, clinically relevant information on coagulopathy, and outcome, and thus help guide treatment modality in sepsis and septic shock-induced coagulopathy.
Mohapatra P, Kumar A, Singh RK, Gupta R, Hussain M, Singh S, . The Effect of Sepsis and Septic Shock on the Viscoelastic Properties of Clot Quality and Mass Using Thromboelastometry: A Prospective Observational Study. Indian J Crit Care Med 2023;27(9):625-634.
脓毒症与广泛多样的凝血异常有关。血栓弹力图（TEG）可有效测量血凝块的粘弹性特性。本研究旨在使用TEG阐述脓毒症和脓毒性休克患者血凝块质量和大小的粘弹性特性，作为一种优于标准凝血试验的有效工具。
进行了一项单中心前瞻性观察性研究。研究纳入了50例符合脓毒症和脓毒性休克标准的患者，以及30例健康受试者。采集血样并进行标准凝血试验、血小板计数、纤维蛋白原检测以及TEG研究。
共纳入130例患者。脓毒性休克患者的序贯（与脓毒症相关的）器官衰竭评分更高。与脓毒症组和对照组相比，凝血酶原时间（PT）和活化部分凝血活酶时间（aPTT）显著延长。与健康组相比，脓毒症组的TEG参数如α角和最大振幅（MA）显著延长，而反应时间（R时间）显著缩短，提示脓毒症患者处于高凝状态。而在脓毒性休克患者中，与所有其他组相比，MA和30分钟溶解指数（LY 30）显著延长，R时间显著缩短。尽管脓毒症患者的LY30在正常范围内（<0.001），但18%的患者LY30延长，表明存在纤维蛋白溶解受损的高凝状态。
血栓弹力图作为一种即时检测方法，结合传统凝血试验，可以提供关于凝血病和预后的额外临床相关信息，从而有助于指导脓毒症和脓毒性休克所致凝血病的治疗方式。
莫哈帕特拉P，库马尔A，辛格RK，古普塔R，侯赛因M，辛格S，. 使用血栓弹力测定法评估脓毒症和脓毒性休克对血凝块质量和大小粘弹性特性的影响：一项前瞻性观察性研究。《印度重症监护医学杂志》2023；27（9）：625 - 634。
