Yeliz KILIÇ, İsmet TOPÇU, Hamza BAMBAL, Melek ÇİVİ

Thromboelastography in the evaluation of coagulation disorders in patients with sepsis

Unbalanced hemostasis and disseminated intravenous coagulopathy serve as key participants in organ dysfunction and disability. In this study we evaluated the coagulation profiles of patients diagnosed with systemic inflammatory syndrome (SIRS)-sepsis and multiple organ dysfunction syndrome. We also researched coagulation in sepsis by comparing thromboelastography (TEG) data with those of nonsepsis patients to determine the usefulness of the TEG device. Materials and methods: Data were collected from 55 anesthesiology and surgery intensive care unit (ICU) patients: 21 with SIRS-sepsis (Group S) and 34 patients without SIRS-sepsis (Group C). Blood samples were taken upon admission to the ICU (t1) and on day 3 of the ICU stay (t2). TEG data (R = reaction time, K = coagulation time, a = alpha angle, and MA = maximum amplitude) were recorded. TEG parameters were compared with routine coagulation and hemogram studies. Results: The mean R value in Group C was higher than that of Group S at both t1 and t2. Group S had a significantly lower K value and higher alpha angle at t1 compared to Group C (P < 0.05). Conclusion: Hypercoagulability was observed in SIRS-sepsis patients in the ICU, as measured with TEG. We believe that TEG will be a useful tool in the evaluation of coagulation disorders developing in septic critically ill patients.

Anahtar Kelimeler:

Key words: Sepsis, coagulation, thromboelastography

Thromboelastography in the evaluation of coagulation disorders in patients with sepsis

Keywords:

Key words: Sepsis, coagulation, thromboelastography,

PDF

___

Reinhart K, Bloos F, Brunkhorst FM. Pathophysiology of sepsis and multiple organ dysfunction. In Fink MP, Abraham E, Vincent JL, Kochanek PM, editors. Textbook of Critical Care. 5th ed. Philadelphia, PA, USA: Elsevier-Saunders; 2005. pp. 1249–1258.
Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 1992; 101: 1644–1655.
Vincent JL. Sepsis: the systemic inflammatory response. In Papadakos PJ, Szalados JE, editors. Critical Care - The Requisites in Anesthesiology. Philadelphia, PA, USA: Elsevier Mosby; 2005. pp. 3–10.
Bolliger D, Seeberger MD, Tanaka KA. Principles and practice of thromboelastography in clinical coagulation management and transfusion practice. Transfus Med Rev 2012; 26: 1–13.
Topçu I, Çivi M, Öztürk T, Keleş GT, Çoban S, Yentür EA, Okçu G. Evaluation of hemostatic changes using thromboelastography after crystalloid or colloid fluid administration during major orthopedic surgery. Braz J Med Biol Res 2012; 45: 869–874.
Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 2001; 29: 1303–1310.
Yıldız BD, Yorgancı K. Current trends and future implications in sepsis treatment. Turk J Med Sci 2008; 38: 501–510.
Ceylan BG, Yavuz L, Eroğlu F, Gülmen Ş, Tarhan ÖR, Alaca A. The effects of adjuvant therapies for sepsis on hepatic and renal function: a retrospective analysis of 108 ICU patients. Turk J Med Sci 2010; 40: 949–957.
Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med 2003; 348: 1546–1554.
Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D Cohen J, Opal SM, Vincent JL, Ramsay G; SCCM/ ESICM/ACCP/ATS/SIS. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 2003; 31: 1250–1256.
Balk RA. Severe sepsis and septic shock: definitions, epidemiology, and clinical manifestations. Crit Care Clin 2000; 16: 179–192.
Meço BC, Cuhruk FH, Tulunay M, Oral M, Ünal MN. Can plasma free-DNA concentration be a diagnostic tool in critically ill septic patients? Turk J Med Sci 2013; 43: 150–155.
Levi M, Schultz M, van der Poll T. Disseminated intravascular coagulation in infectious disease. Semin Thromb Hemost 2010; 36: 367–377.
Laterre PF, Levy H, Clermont G, Ball DE, Garg R, Nelson DR, Dhainaut JF, Angus DC. Hospital mortality and resource use in subgroups of the Recombinant Human Activated Protein C Worldwide Evaluation in Severe Sepsis (PROWESS) trial. Crit Care Med 2004; 32: 2207–2218.
Kinasewitz GT, Yan SB, Basson B, Comp P, Russell JA, Cariou A, Um SL, Utterback B, Laterre PF, Dhainaut JF; PROWESS Sepsis Study Group. Universal changes in biomarkers of coagulation and inflammation occur in patients with severe sepsis, regardless of causative micro-organism. Critical Care 2004; 8: R82–90.
Taylor FB Jr, Toh CH, Hoots WK, Wada H, Levi M. Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. Thromb Haemost 2001; 86: 1327–1330.
Harris RL, Musher DM, Bloom K, Gathe J, Rice L, Sugarman B, Williams TW Jr, Young EJ. Manifestation of sepsis. Arch Intern Med 1987; 147: 1895–1906.
Mallett SV, Cox DJ. Thrombelastography. Br J Anaesth 1992; 69: 307–313.
Francis JL, Francis DA, Gunathilagan GJ. Assessment of hypercoagulability in patients with cancer using the Sonoclot Analyzer and thromboelastography. Thromb Res 1994; 74: 335–346.
Sivula M, Pettila V, Niemi TT, Varpula M, Kuitunen AH. Thromboelastometry in patients with severe sepsis and disseminated intravascular coagulation. Blood Coagul Fibrinolysis 2009; 20: 419–426.
Daudel F, Kessler U, Folly H, Linert JS, Takala J, Jacob SM. Thromboelastometry for the assessment of coagulation abnormalities in early and established adult sepsis: a prospective cohort study. Crit Care Med 2009; 13: R42.
Ganter MT, Hofer CK. Coagulation monitoring: current techniques and clinical use of viscoelastic point-of care coagulation devices. Anesth Analg 2008; 106: 1366–1375.
Spiel AO, Mayr FB, Firbas C, Quehenberger P, Jilma B. Validation of rotation thrombelastography in a model of systemic activation of fibrinolysis and coagulation in humans. J Thromb Haemos 2006; 4: 411–416.
Collins PW, Macchiavello LI, Lewis SJ, Macartney NJ, Saayman AG, Luddington R, Baglin T, Findlay GP. Global tests of haemostasis in critically ill patients with severe sepsis syndrome compared to controls. Br J Haematol 2006; 135: 220–227.
Grant HW, Hadley GP. Prediction of neonatal sepsis by tromboelastography. Pediatr Surg Int 1997; 12: 289–292.
Reikvam H, Steien E, Hauge B, Liseth K, Hagen KG, Stİrkson R, Hervig T. Thromboelastography. Transfus Apher Sci 2009; 40: 119–123.
Gonano C, Sitzwohl C, Meitner E, Weinstabl C, Kettner SC. Four-day antithrombin therapy does not seem to attenuate hypercoagulability in patients suffering from sepsis. Crit Care 2006; 10: R160.
McCrath DJ, Cerboni E, Frumento RJ, Hirsh AL, BennettGuerrero E. Thromboelastography maximum amplitude predicts postoperative thrombotic complications including myocardial infarction. Anesth Analg 2005; 100: 1576–1583.
Rafiq S, Johansson PI, Ostrowski SR, Stissing T, Steinbrüchel DA. Hypercoagulability in patients undergoing coronary artery bypass grafting: prevalence, patient characteristics and postoperative outcome. Eur J Cardiothorac Surg 2012; 41: 550–555.
Mahla E, Lang T, Vicenzi MN, Werkgartner G, Maier R, Probst C, Metzler H. Thromboelastography for monitoring prolonged hypercoagulability after major abdominal surgery. Anesth Analg 2001; 92: 572–577.