Thromboelastometric evaluation of sepsis associated coagulopathy: a cohort study

Área: Hospitalar

MARCUS VINICIUS MELO DE ANDRADE

IVAN EUCLIDES BORGES SARAIVA
Clara R. A. Oliveira
Thiago L. B. S. Ataíde
Vandack Nobre Junior

Introduction: Sepsis is often complicated by coagulopathy. Conventional coagulation tests may be insufficient to completely evaluate patients with sepsis. Thromboelastometry provides a global assessment of clotting and could theoretically overcome the limitations of conventional coagulation tests. Methods and Results: In this study we included 50 patients with severe sepsis and septic shock, median age 48.5 years, 58% male sex, 44% with hypertension, 20% with diabetes mellitus, 14% with previous myocardial infarction, and 14% with heart failure. APACHE II median score was 17, SOFA median score in the first day (D1) was 7. Overall mortality was 14% in 7 days and 28% in 28 days. Sepsis had culture confirmation in 34%, being most common Escherichia coli (10%), Acinetobacter baumannii (10%), and Enterococcus faecalis (8%). Disseminated intravascular coagulation (DIC) was present in D1 in 28.26%. Thromboelastometric variable Clot Formation Time (CFT) in D1 was predictive of DIC with and area under the ROC curve of 0.71. Thromboelastometric variables Clotting Time (CT), CFT, alpha angle and Maximum Clot Firmness (MCF) showed hypocoagulability in 88%, 70%, 66%, and 30% respectively in D1. Increase in CT and CFT in D3 and increase in CT in D7 were associated with microbiological confirmation of sepsis (P < 0.01 for all). Increase in CFT in D1 was associated with 28-day mortality (p = 0.02). Increase in CT and CFT in D3 and increase in CT in D7 were associated with 28-day mortality (p < 0.01 for all). The area under the ROC curve for the predictive ability of CT in D3 for 28-day mortality was 0.77. Nevertheless, when patients were compared with respect to the presence or absence of hypocoagulability based on thromboelastometric variables, there was no significant increase in risk for death. Conclusion: patients with severe sepsis and septic shock showed a thromboelastometric profile predominantly hypocoagulable, and the changes in thromboelastometric variables were associated with mortality.