Koami Hiroyuki, Sakamoto Yuichiro, Hirota Yuri, Sasaki Akira, Ogawa Hirotaka, Furukawa Yutaro, Matsuoka Ayaka, Shinada Kota, Nakayama Kento, Sakurai Ryota, Iwanaga Sachiko, Onohara Takayuki, Narumi Shogo, Koba Mayuko
Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, 5-1-1, Nabeshima, Saga City, Saga 849-8501, Japan.
Thromb Res. 2025 Jan;245:109235. doi: 10.1016/j.thromres.2024.109235. Epub 2024 Dec 4.
This study investigated the utility of thromboelastometry (ROTEM) in assessing hypofibrinolysis among septic patients, specifically the association of hypofibrinolysis, as determined by ROTEM, with septic disseminated intravascular coagulation (DIC), organ dysfunction, and clinical outcomes.
This single-center, retrospective analysis included adult septic patients admitted to Saga University Hospital from 2013 to 2017, with available ROTEM data. Hypofibrinolysis was assessed using the lysis index at 60 min (LI60) in extrinsic thromboelastometry (EXTEM). Based on their LI60 values, patients were classified into three groups: Hyper (LI60 ≤ 85), Normal (LI60 86-96), and Hypo (LI60 ≥ 97).
Among the 63 cases analyzed, the Hypo group showed significantly higher APACHEII and SOFA scores than the Normal group, indicating greater disease severity. Similarly, DIC and sepsis-induced coagulopathy (SIC) scores were notably higher in the Hypo group. The diagnostic performance of LI60 for ISTH-overt DIC showed an area under the curve (AUC) of 0.954, with an optimal cutoff value of 97 %, achieving 100 % sensitivity and 83.3 % specificity. The odds ratio for ISTH-overt DIC was 2.894, indicating a strong association between elevated LI60 and occurrence of DIC. Hypofibrinolysis predicted 28-day mortality and high SOFA scores (≥ 10) with high specificity and negative predictive value (NPV). A Kaplan-Meier curve revealed that the Hypo Group showed significantly worse clinical outcomes than the Normal and Hyper groups.
For septic patients, fibrinolysis suppression presenting as "hypofibrinolysis" (elevated LI60) is associated with poor prognosis and risk of higher organ dysfunction. Moreover, it is a significant predictor of adverse clinical outcomes in sepsis.
本研究探讨了血栓弹力图（ROTEM）在评估脓毒症患者低纤维蛋白溶解方面的效用，特别是由ROTEM测定的低纤维蛋白溶解与脓毒症弥散性血管内凝血（DIC）、器官功能障碍及临床结局之间的关联。
这项单中心回顾性分析纳入了2013年至2017年入住佐贺大学医院且有可用ROTEM数据的成年脓毒症患者。采用外源性血栓弹力图（EXTEM）中60分钟时的溶解指数（LI60）评估低纤维蛋白溶解情况。根据LI60值，将患者分为三组：高纤维蛋白溶解组（LI60≤85）、正常纤维蛋白溶解组（LI60 86 - 96）和低纤维蛋白溶解组（LI60≥97）。
在分析的63例病例中，低纤维蛋白溶解组的急性生理与慢性健康状况评分系统II（APACHEII）和序贯器官衰竭评估（SOFA）评分显著高于正常纤维蛋白溶解组，表明疾病严重程度更高。同样，低纤维蛋白溶解组的DIC和脓毒症诱导的凝血病（SIC）评分明显更高。LI60对国际血栓与止血学会（ISTH）显性DIC的诊断效能显示曲线下面积（AUC）为0.954，最佳截断值为97%，灵敏度达100%，特异度为83.3%。ISTH显性DIC的优势比为2.894，表明LI60升高与DIC发生之间存在强关联。低纤维蛋白溶解以高特异度和阴性预测值（NPV）预测28天死亡率和高SOFA评分（≥10）。Kaplan - Meier曲线显示，低纤维蛋白溶解组的临床结局明显比正常纤维蛋白溶解组和高纤维蛋白溶解组差。
对于脓毒症患者，表现为“低纤维蛋白溶解”（LI60升高）的纤维蛋白溶解抑制与预后不良及更高的器官功能障碍风险相关。此外，它是脓毒症不良临床结局的重要预测指标。
