Value of thromboelastography in evaluating the 28 d survival rate in sepsis patients

doi:10.3877/cma.j.issn.1674-6880.2018.04.004

Abstract

Abstract:

Objective

To explore the value of thromboelastography in evaluating 28-day survival rate in sepsis patients.

Methods

Totally 50 patients with sepsis admitted to Department of Critical Care Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University from April 2017 to November 2017 were divided into the survival group (34 cases) and death group (16 cases) according to the prognosis of patients at 28 days. The age, sex ratio, and pathogen type of infection were compared between the two groups. The general data, including acute physiology and chronic health evaluation (APACHE) Ⅱ score, sequential organ failure assessment (SOFA) score, continuous veno-venous hemofiltration (CVVH)/ continuous veno-venous hemodialysis (CVVHD), C reactive protein, procalcitonin, platelet count, international normalized ratio (INR), N-terminal brain natriuretic peptide (NT-proBNP), and the use of mechanical ventilation, blood purification therapy, and vasopressor drugs, were compared between these two groups, as well as thromboelastography indexes of coagulation reaction time (R value), hemagglutination time (K value), rate of fibrin clot formation and reinforcement (alpha angle) and maximum strength and hardness of reactive blood clot (MA value). Multivariate Cox regression analysis was used to evaluate the prognostic value of each index on sepsis patients.

Results

The APACHEⅡ scores of sepsis patients [(27 ± 6) vs. (22 ± 6), t= 2.611, P= 0.012] were significantly higher in the death group than in the survival group. The R value [9.50 (8.23, 13.30) min vs. 6.55 (6.03, 8.15) min, H= 3.381, P= 0.001], and K value [3.50 (1.95, 4.50) min vs. 1.25 (1.08, 2.05) min, Z= 4.955, P < 0.001] of sepsis patients were significantly longer, and the alpha angle [47.50 (39.90, 62.45) vs. 71.80 (62.00, 74.70), H= 4.004, P < 0.001] and MA value [58.10 (48.70, 67.58) vs. 67.10 (60.13, 70.65), H= 2.433, P= 0.015] were significantly lower in the death group than in the survival group. Cox multivariate regression showed that the alpha angle < 53° in the thromboelastography was the influencing factor of 28-day survival rate in sepsis patients [HR= 3.463, 95%CI (1.250, 9.599), P= 0.017].

Conclusion

The alpha angle in the thromboelastography has a certain predictive value for the prognosis of sepsis patients.

Key words: Sepsis, Thromboelastography, Alpha angle

Fang Kuang, Zhijie He, Minggen Zhou, Zijun Zou, Canxia Huang, Chun Chen. Value of thromboelastography in evaluating the 28 d survival rate in sepsis patients[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2018, 11(04): 233-237.

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References 20

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组别	例数	年龄（岁， ± s)	性别比（例，男/女）	恶性肿瘤[例(%)]	APACHEⅡ评分（分， ± s）	SOFA评分[分，M(P₂₅,P₇₅)]	CVVH/CVVHD[例(%)]
存活组	34	59 ± 18	21/13	14(41.18)	22 ± 6	6.0(4.0,8.0)	1(2.94)
死亡组	16	66 ± 17	13/3	4(25.00)	27 ± 6	7.5(5.0,11.0)	4(25.00)
H/χ²/t值	?	1.338	1.902	1.244	2.611	1.402	3.687
P值	?	0.188	0.168	0.266	0.012	0.161	0.055
组别	例数	?	感染类型[例(%)]				机械通气[例(%)]
组别	例数	革兰阴性菌	革兰阳性菌	真菌	病毒	培养阴性	机械通气[例(%)]
存活组	34	17(50.00)	5(14.71)	4(11.76)	1(2.94)	7(20.59)	29(85.29)
死亡组	16	4(25.00)	4(25.00)	4(25.00)	0	4(25.00)	16(100.00)
H/χ²/t值	?	4.020					1.243
P值	?	0.404					0.145
组别	例数	升压药的应用[例(%)]	降钙素原[μg/L，M(P₂₅,P₇₅)]	C反应蛋白[mg/L，M(P₂₅,P₇₅)]	血小板计数（×10⁹/L, ± s)	INR[M(P₂₅,P₇₅)]	NT-proBNP[μg/L, M(P₂₅,P₇₅)]
存活组	34	9(26.47)	1.01(0.37,3.80)	88.90(20.00,160.30)	198 ± 107	1.21(1.09,1.36)	1.30(0.25,5.38)
死亡组	16	6(37.50)	3.25(0.80,21.67)	113.20(87.26,200.00)	186 ± 100	1.20(1.06,1.33)	4.27(0.44,18.42)
H/χ²/t值	?	0.208	1.460	1.711	0.377	0.592	1.885
P值	?	0.643	0.145	0.088	0.703	0.553	0.058

组别	例数	年龄（岁， ± s)	性别比（例，男/女）	恶性肿瘤[例(%)]	APACHEⅡ评分（分， ± s）	SOFA评分[分，M(P₂₅,P₇₅)]	CVVH/CVVHD[例(%)]
存活组	34	59 ± 18	21/13	14(41.18)	22 ± 6	6.0(4.0,8.0)	1(2.94)
死亡组	16	66 ± 17	13/3	4(25.00)	27 ± 6	7.5(5.0,11.0)	4(25.00)
H/χ²/t值	?	1.338	1.902	1.244	2.611	1.402	3.687
P值	?	0.188	0.168	0.266	0.012	0.161	0.055
组别	例数	?	感染类型[例(%)]				机械通气[例(%)]
组别	例数	革兰阴性菌	革兰阳性菌	真菌	病毒	培养阴性	机械通气[例(%)]
存活组	34	17(50.00)	5(14.71)	4(11.76)	1(2.94)	7(20.59)	29(85.29)
死亡组	16	4(25.00)	4(25.00)	4(25.00)	0	4(25.00)	16(100.00)
H/χ²/t值	?	4.020					1.243
P值	?	0.404					0.145
组别	例数	升压药的应用[例(%)]	降钙素原[μg/L，M(P₂₅,P₇₅)]	C反应蛋白[mg/L，M(P₂₅,P₇₅)]	血小板计数（×10⁹/L, ± s)	INR[M(P₂₅,P₇₅)]	NT-proBNP[μg/L, M(P₂₅,P₇₅)]
存活组	34	9(26.47)	1.01(0.37,3.80)	88.90(20.00,160.30)	198 ± 107	1.21(1.09,1.36)	1.30(0.25,5.38)
死亡组	16	6(37.50)	3.25(0.80,21.67)	113.20(87.26,200.00)	186 ± 100	1.20(1.06,1.33)	4.27(0.44,18.42)
H/χ²/t值	?	0.208	1.460	1.711	0.377	0.592	1.885
P值	?	0.643	0.145	0.088	0.703	0.553	0.058

组别	例数	R值(min)	K值(min)	α角（°）	MA值(mm)
存活组	34	6.55(6.03,8.15)	1.25(1.08,2.05)	71.80(62.00,74.70)	67.10(60.13,70.65)
死亡组	16	9.50(8.23,13.30)	3.50(1.95,4.50)	47.50(39.90,62.45)	58.10(48.70,67.58)
H值	?	3.381	4.955	4.004	2.433
P值	?	0.001	< 0.001	< 0.001	0.015

组别	例数	R值(min)	K值(min)	α角（°）	MA值(mm)
存活组	34	6.55(6.03,8.15)	1.25(1.08,2.05)	71.80(62.00,74.70)	67.10(60.13,70.65)
死亡组	16	9.50(8.23,13.30)	3.50(1.95,4.50)	47.50(39.90,62.45)	58.10(48.70,67.58)
H值	?	3.381	4.955	4.004	2.433
P值	?	0.001	< 0.001	< 0.001	0.015

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