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Role of Thromboelastography as an Early Predictor of Disseminated Intravascular Coagulation in Patients with Septic Shock

Authors
 Sang Min Kim  ;  Sang-Il Kim  ;  Gina Yu  ;  June-Sung Kim  ;  Seok In Hong  ;  Bora Chae  ;  Yo Sep Shin  ;  Youn Jung Kim  ;  Seongsoo Jang  ;  Won Young Kim 
Citation
 JOURNAL OF CLINICAL MEDICINE, Vol.9(12) : 3883, 2020-11 
Journal Title
JOURNAL OF CLINICAL MEDICINE
Issue Date
2020-11
Keywords
septic shock ; disseminated intravascular coagulation ; thromboelastography ; predictor
Abstract
(1) Background: The currently proposed criteria for diagnosing overt disseminated intravascular coagulation (DIC) are not suitable for early detection of DIC. Thromboelastography (TEG) rapidly provides a comprehensive assessment of the entire coagulation process and is helpful as a guide for correcting consumptive coagulopathy in sepsis-induced DIC. This study aimed to investigate the role of TEG in the prediction of DIC in patients with septic shock. (2) Methods: TEG was conducted prospectively in 1294 patients with septic shock at the emergency department (ED) between January 2016 and December 2019. After exclusion of 405 patients with "do not attempt resuscitation" orders, those refusing enrollment, and those developing septic shock after ED presentation, 889 patients were included. DIC was defined as an International Society on Thrombosis and Hemostasis score >= 5 points within 24 h. (3) Results: Of the 889 patients with septic shock (mean age 65.6 +/- 12.7 years, 58.6% male), 158 (17.8%) developed DIC. TEG values, except lysis after 30 min, were significantly different between the DIC and non-DIC groups. Among the TEG values, the maximal amplitude (MA) had the highest discriminating power for DIC, with an area under the curve of 0.814. An MA < 60 indicated DIC with 79% sensitivity, 73% specificity, and 94% negative predictive value. Based on multivariable analysis, MA < 60 was an independent predictor of DIC (odds ratio 5.616 (95% confidence interval: 3.213-9.818)). (4) Conclusions: In patients with septic shock, the MA value in TEG could be a valuable tool for early prediction of DIC.
Files in This Item:
T9992020115.pdf Download
DOI
10.3390/jcm9123883
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Emergency Medicine (응급의학교실) > 1. Journal Papers
Yonsei Authors
Yu, Gina(유지나)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/189897
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