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 |