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

(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 correct...

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Autores principales: Kim, Sang Min, Kim, Sang-Il, Yu, Gina, Kim, June-Sung, Hong, Seok In, Chae, Bora, Shin, Yo Sep, Kim, Youn Jung, Jang, Seongsoo, Kim, Won Young
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7760761/
https://www.ncbi.nlm.nih.gov/pubmed/33260354
http://dx.doi.org/10.3390/jcm9123883
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author Kim, Sang Min
Kim, Sang-Il
Yu, Gina
Kim, June-Sung
Hong, Seok In
Chae, Bora
Shin, Yo Sep
Kim, Youn Jung
Jang, Seongsoo
Kim, Won Young
author_facet Kim, Sang Min
Kim, Sang-Il
Yu, Gina
Kim, June-Sung
Hong, Seok In
Chae, Bora
Shin, Yo Sep
Kim, Youn Jung
Jang, Seongsoo
Kim, Won Young
author_sort Kim, Sang Min
collection PubMed
description (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.
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spelling pubmed-77607612020-12-26 Role of Thromboelastography as an Early Predictor of Disseminated Intravascular Coagulation in Patients with Septic Shock Kim, Sang Min Kim, Sang-Il Yu, Gina Kim, June-Sung Hong, Seok In Chae, Bora Shin, Yo Sep Kim, Youn Jung Jang, Seongsoo Kim, Won Young J Clin Med Article (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. MDPI 2020-11-29 /pmc/articles/PMC7760761/ /pubmed/33260354 http://dx.doi.org/10.3390/jcm9123883 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Kim, Sang Min
Kim, Sang-Il
Yu, Gina
Kim, June-Sung
Hong, Seok In
Chae, Bora
Shin, Yo Sep
Kim, Youn Jung
Jang, Seongsoo
Kim, Won Young
Role of Thromboelastography as an Early Predictor of Disseminated Intravascular Coagulation in Patients with Septic Shock
title Role of Thromboelastography as an Early Predictor of Disseminated Intravascular Coagulation in Patients with Septic Shock
title_full Role of Thromboelastography as an Early Predictor of Disseminated Intravascular Coagulation in Patients with Septic Shock
title_fullStr Role of Thromboelastography as an Early Predictor of Disseminated Intravascular Coagulation in Patients with Septic Shock
title_full_unstemmed Role of Thromboelastography as an Early Predictor of Disseminated Intravascular Coagulation in Patients with Septic Shock
title_short Role of Thromboelastography as an Early Predictor of Disseminated Intravascular Coagulation in Patients with Septic Shock
title_sort role of thromboelastography as an early predictor of disseminated intravascular coagulation in patients with septic shock
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7760761/
https://www.ncbi.nlm.nih.gov/pubmed/33260354
http://dx.doi.org/10.3390/jcm9123883
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