Whole-blood hypocoagulable profile correlates with a greater risk of death within 28 days in patients with severe sepsis

BACKGROUNDHypocoagulability and impaired platelet function have been associated with a high risk of death in sepsis. The aim of this cohort study was to determine whether sepsis-induced hypocoagulability and platelet dysfunction (assessed by ROTEM® and MULTIPLATE®, respectively) are increased in sep...

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Published in:Korean journal of anesthesiology 2020, 73(3), , pp.224-231
Main Authors: Boscolo, Annalisa, Spiezia, Luca, Campello, Elena, Bertini, Diana, Lucchetta, Vittorio, Piasentini, Eleonora, De Cassai, Alessandro, Simioni, Paolo
Format: Article
Language:English
Subjects:
Clinical
coagulopathy
hypocoagulability
multiplate
rotem
severe sepsis
thromboelastometry
마취과학
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Summary:BACKGROUNDHypocoagulability and impaired platelet function have been associated with a high risk of death in sepsis. The aim of this cohort study was to determine whether sepsis-induced hypocoagulability and platelet dysfunction (assessed by ROTEM® and MULTIPLATE®, respectively) are increased in sepsis patients who died within 28 days after diagnosis compared with patients who died between 29 and 90 days after diagnosis. METHODSConsecutive patients admitted to the intensive care unit of Padova University Hospital from March 2015 to March 2018 for severe sepsis were considered. We collected blood samples from all patients to determine ROTEM® and MULTIPLATE® parameters. Each enrolled patient underwent a 90-day follow-up and the mortality rate was recorded. RESULTSOf 120 patients, 36 (30%) died within 28 days post-diagnosis (Group A), 23 (19%) died between days 29 and 90 post-diagnosis (Group B), and 61 (51%) were alive after 90 days (survivors). The clotting time in the ROTEM® test and clot formation time in the EXTEM test were significantly more prolonged in Group A than in B. Both groups showed a significantly higher hypocoagulability than survivors in the EXTEM test. MULTIPLATE® platelet function analysis showed that platelet function was significantly lower in Group A than in Group B. CONCLUSIONSThe present study showed that the combination of thromboelastometry and impedance aggregometry may help identifying sepsis patients at high risk of short-term death. Larger studies are warranted to corroborate our results.
ISSN:2005-6419
2005-7563
DOI:10.4097/kja.19396