Hypocoaguability predicts 30-day ICU survival
MedWire News: Intensive care unit (ICU) patients with hypocoaguability on admission have an increased short-term risk for death, demonstrate the results of a thromboelastography (TEG) study.
In addition, patients with hypocoaguability required more ventilator treatment, a higher rate of renal replacement therapy, and more blood products than patients with normal TEG results on admission to the ICU, the Danish team reports in the journal Blood Coagulation and Fibrinolysis.
Pär Johansson (Rigshospitalet, University of Copenhagen) and co-workers examined the impact of the whole-blood assay in 106 medical, surgical, and trauma patients admitted to ICU who were expected to stay for more than 24 hours.
TEG was performed on admission and the patients’ Acute Physiology and Chronic Health Evaluation (APACHE) II and sequential organ failure assessment scores (SOFA) were noted.
Overall, 42% of patients were classified as hypocoagulable using TEG and these patients had significantly higher first day SOFA scores than those with normal TEG results.
Moreover, 42% of hypocoaguable patients had died within 30 days of ICU admission compared with just 13% of patients with a normal TEG result.
Thirty-day survivors had higher admission platelet counts than those who died, as well as significantly different TEG findings for clotting time, clot strength, and platelet function.
In multivariate analysis adjusting for age and APACHE II score, TEG-defined hypocoaguability independently predicted 30-day mortality (odds ratio=3.5), Johansson et al report.
“Interestingly, none of the plasma-based coagulation analyses, including activated partial thromboplastin time, coagulation factors II, VII, X, and international normalized ratio, differed at ICU admission between subsequent survivors and nonsurvivors,” they conclude.
“This suggests that coagulopathy in general ICU patients at admission may better be identified by a whole-blood analysis, which reflects the interaction between the platelets, the clotting factors and fibrinolytic activity.”
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By Lynda Williams