The Effect of Sepsis and Septic Shock on the Viscoelastic Properties of Clot Quality and Mass Using Thromboelastometry: A Prospective Observational Study

Priyanka Mohapatra; Arvind Kumar; Rakesh Kumar Singh; Ruchi Gupta; Mumtaz Hussain; Swati Singh; Pankaj Kumar

doi:10.5005/jp-journals-10071-24539

The Effect of Sepsis and Septic Shock on the Viscoelastic Properties of Clot Quality and Mass Using Thromboelastometry: A Prospective Observational Study

Indian J Crit Care Med. 2023 Sep;27(9):625-634. doi: 10.5005/jp-journals-10071-24539.

Authors

Priyanka Mohapatra¹, Arvind Kumar¹, Rakesh Kumar Singh¹, Ruchi Gupta², Mumtaz Hussain¹, Swati Singh¹, Pankaj Kumar¹

Affiliations

¹ Department of Anesthesiology & Critical Care Medicine, Indira Gandhi Institute of Medical Science, Patna, Bihar, India.
² Department of Critical Care, Holy Family Hospital, New Delhi, India.

Abstract

Background: Sepsis is associated with wide variable coagulation abnormalities. Thromboelastography (TEG) effectively measures the viscoelastic properties of the clots. This study aims to illustrate the viscoelastic properties of clot quality and mass in sepsis and septic shock patients using TEG, as an effective tool over standard coagulation tests.

Materials and methods: A single-center, prospective observational study was conducted. 50 patients each meeting the criteria for sepsis and septic shock, and a healthy group of 30 patients was included in the study. Blood samples were obtained and analyzed for standard coagulation tests, platelet count, fibrinogen, and TEG study.

Results: A total of 130 patients were included. Septic shock patients had a higher sequential (sepsis-related) organ failure score. Prothrombin time (PT) and activated partial thromboplastin time (aPTT) were increased significantly as compared to the sepsis and control groups. TEG markers such as alpha angle, and maximum amplitude (MA) were significantly prolonged while reaction time (R time), was significantly shortened in the sepsis group as compared to the healthy group, suggestive of a hypercoagulable state in sepsis patients. While in septic shock patients, MA and Lysis Index 30 (LY 30) were significantly prolonged and, R time was significantly shortened compared to all other groups. Even though LY30 in sepsis patients was found to be within the normal range (p < 0.001), 18% of patients had prolonged LY30 indicating a hypercoagulable state with impaired fibrinolysis.

Conclusion: Thromboelastography, as a point-of-care test combined with conventional coagulation tests can provide additional, clinically relevant information on coagulopathy, and outcome, and thus help guide treatment modality in sepsis and septic shock-induced coagulopathy.

How to cite this article: Mohapatra P, Kumar A, Singh RK, Gupta R, Hussain M, Singh S, et al. The Effect of Sepsis and Septic Shock on the Viscoelastic Properties of Clot Quality and Mass Using Thromboelastometry: A Prospective Observational Study. Indian J Crit Care Med 2023;27(9):625-634.

Keywords: Biomarkers; Coagulation tests; Coagulopathy; Hypercoagulable state; Observational studies as topic; Sepsis; Septic shock; Severity; Systemic inflammatory response syndrome; fibrinolysis.