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Role of thromboelastography in the evaluation of septic shock patients with normal prothrombin time and activated partial thromboplastin time

 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 
 SCIENTIFIC REPORTS, Vol.11(1) : 11833, 2021-06 
Journal Title
Issue Date
Aged ; Blood Coagulation ; Blood Coagulation Tests ; Emergency Service, Hospital / statistics & numerical data ; Female ; Humans ; Male ; Middle Aged ; Partial Thromboplastin Time* ; Prospective Studies ; Prothrombin Time* ; Registries ; Republic of Korea / epidemiology ; Shock, Septic / blood* ; Shock, Septic / diagnostic imaging* ; Thrombelastography / methods* ; Treatment Outcome
Coagulopathy is frequent in septic shock and plays a key role in multiple organ dysfunction. The aim of this study is to investigate application values of thromboelastography (TEG) for outcome in septic shock patients with a normal value of prothrombin time (PT) and active partial thromboplastin time (aPTT). Prospective observational study using 1298 consecutive septic shock patients with TEG at admission was conducted at the emergency department (ED) of a tertiary care hospital in South Korea between 2016 and 2019. After excluding overt-disseminated intravascular coagulation (DIC) defined by scoring system, we included patients with a normal value of international normalized ratio ≤ 1.3 and aPTT ≤ 34 s. The primary outcome was 28-day mortality. 893 patients were included and 129 patients with overt DIC were excluded. Of the 764 remaining patients, 414 (54.2%) patients showed normal PT and aPTT (28-day mortality rate, 11.4%). TEG values such as reaction time, kinetic time (K), alpha angle (α), maximum amplitude (MA) and lysis index (LY 30) showed no significant mean difference between the survivor and non-survivor groups. However, hypocoagulable TEG values such as α < 53° (12.0% vs. 23.4%; p = 0.039), and MA < 50 mm (6.3% vs. 21.3%; p = 0.002) were significantly higher in the non-survived group. In multivariate analysis, hypocoagulable state (defined as K > 3 and α < 53 and MA < 50) was independent factors associated with increased risk of death (OR 4.882 [95% CI, 1.698-14.035]; p = 0.003). In conclusion, septic shock patients with normal PT and aPTT can be associated with impaired TEG profile, such as hypocoagulability, associated with increased mortality.
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1. College of Medicine (의과대학) > Dept. of Emergency Medicine (응급의학교실) > 1. Journal Papers
Yonsei Authors
Yu, Gina(유지나)
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