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Table 2 Studies assessing TEG/ROTEM in sepsis

From: Utility of thromboelastography and/or thromboelastometry in adults with sepsis: a systematic review

Author, year Type of study Population ( N) ROTEM or TEG Timing of measurement Comparison Main ROTEM/TEG findings
Gonano [40] Subanalysis of randomized controlled trial Severe sepsis (n = 33) TEG At diagnosis and daily thereafter. PT, APTT, AT All patients were hypercoagulable (shortened R and CT, increased α and MA). Antithrombin treatment did not affect TEG values.
Raineri (abstract) [39] Randomized controlled trial Severe sepsis and septic shock (n = 16) TEG Daily for 2 weeks and day 17, 20, 23, 28 PAI-1 In patients without tight glycemic control (TGC), fibrinolysis was decreased (increased lysis index and increased PAI-1), compared with sepsis patients not treated with TGC.
Collins [43] Prospective observational Sepsis (n = 38), healthy controls (n = 32) ROTEM Not stated PT, APTT fibrinogen, factor levels In sepsis, there was delayed activation of hemostasis, once activated clot formation was exaggerated (increased MCF, α angle, area under clot firmness curve)
Chiari (abstract) [47] Prospective observational Severe sepsis (n = 15) ROTEM Before and first day of treatment with activated protein C APTT, PT Only CT significantly increased with activated protein C treatment
Daudel [44] Prospective cohort Sepsis (n = 30) ROTEM 0-48 hours after diagnosis and at discharge INR, APTT, fibrinogen, individual factors All parameters within reference values. Patients with SOFA >10 had increased coagulation (reduced MCF and alpha and increased CFT).
Schmittinger (abstract) [46] Prospective observational Severe sepsis (n = 49), postoperative SIRS (n = 27) ROTEM Day 1, 4, 7 after admission None All parameters within reference values. Mortality 58.3% in patients with signs of hypocoagulation vs. 9.1% in those with signs of hypercoagulability.
Sivula [41] Prospective observational Severe sepsis (n = 28), healthy controls (n = 8) ROTEM Day 1 APTT, AT, D-dimer, fibrinogen Only sepsis patients with DIC were hypocoagulable compared to healthy controls. CFT, alpha and MCF discriminated well between DIC and non- DIC. Decreased fibrinolysis in all sepsis patients versus controls.
Adamzik [50] Prospective observational Sepsis (n = 56), postoperative controls (n = 52) ROTEM Within 24 hours of sepsis diagnosis Procalcitonin, IL-6, CRP Increased lysis index in sepsis compared to postoperative controls (97 ± 0.3% vs. 92 ± 0.5%, p < 0.001). CFT, alpha and MCF did not differ between groups. Lysis index had best accuracy for diagnosis sepsis.
Altmann [48] Prospective observational Septic shock (n = 16), severe sepsis (n = 7), SIRS (n = 10) ROTEM 0, 12, 24, 48 h after inclusion None All parameters within reference values.
Durila [49] Prospective observational Severe sepsis (n = 44) TEG Not stated INR, APTT, fibrinogen, AT All parameters within reference values.
Adamzik [9] Prospective observational Sepsis (n = 98) ROTEM Within 24 hours of diagnosis INR 39% of sepsis patients had normal CFT, MCF, and α angle, values in 61% with pathologic variable showed broad distribution Hypocoagulable profile associated with increased mortality (OR 4.1; 95% CI 1.4-11.9).
Cortegiani (abstract) [51] Prospective observational Severe sepsis (n = 31), postoperative (n = 31) TEG Within 12 hours of diagnosis None Sepsis patients had lower α angle, other TEG parameters did not differ.
Brenner [54] Prospective observational Septic shock (n = 30), major surgery (n = 30), healthy volunteers (n = 30) ROTEM Sepsis: at diagnosis, 24 h, 4, 7, 14, 28 days Prothrombin index, factor levels, IL-6, TNF-α In sepsis patients, majority of ROTEM analysis within reference values; however, sepsis patients with DIC showed more hypocoagulable traces compared with those without DIC were more hypercoagulable Compared with surgical and healthy controls fibrinolysis was impaired in sepsis patients.
Durila [53] Prospective observational Postsurgical esophagectomy (n = 38), of these, nine developed sepsis. TEG Morning of surgery and daily day 1-6 post operative APTT, INR, CRP, lactate, IL-6, procalcitonin, AT, D-dimer On postoperative day 6, sepsis patients had higher lysis index compared with SIRS patients. Overall TEG not helpful in discriminating sepsis from SIRS
Massion [52] Prospective cohort Septic shock (n = 39) ROTEM Admission to day 7 APTT, PT, Thrombin generation, factor levels, AT, protein C Fibrinolysis was decreased (increased lysis indexes), associated with hypocoagulation in conventional coagulation tests (decreased protein C and AT). Other parameters within reference values (CT, MCF and alpha). Nonsurvivors were more hypocoagulable, but ROTEM values were not independently associated with mortality
Ostrowski [10] Prospective observational Severe sepsis (N = 13) and septic shock (N = 37) TEG Day 1-4 ISTH DIC score, INR, APTT, D-dimer, fibrinogen, CRP According to cloth strength (MA), 48% of sepsis patients was normocoagulable, 22% hypocoagulable and 30% hypercoagulable. 50% of patients with hypocoagulable profile had overt DIC, versus none of those with a hypercoagulable profile. Hypocoagulable profile predicts 28-day mortality if corrected for SOFA, but not if corrected for SAPS II score.
Viljoen [42] Not stated Sepsis (n = 15), trauma (n = 14), surgery (n = 21), healthy control (n = 23) TEG Daily Plasma elastase-α sub 1 PI Sepsis patients were hypocoagulable compared with surgery patients and controls. Sepsis patients had higher elastase-α sub1 proteinase inhibitor levels compared with controls, without a correlation with TEG parameters.
Umgelter (abstract) [45] Not stated Sepsis (n = 21), no sepsis (n = 23) ROTEM Not stated Thrombin time, D-dimer, AT ROTEM did not discriminate between septic and nonseptic cirrhosis patients