Thromboelastography (TEG) and hemostatic parameters as the diagnostic parameter of septic mortality in the intensive care unit

Abstract

Objective: This study aimed to determine the relationship between thromboelastography (TEG) and hemostatic parameters and the Sequential Organ Failure Assessment (SOFA) score and mortality of septic patients, and found the potential of those parameters to be the mortality diagnostic parameters.

Design: This was a prospective cohort study.

Setting: This study was conducted in the Intensive Care Unit of Dr. Saiful Anwar General Hospital.

Patients and participant: This study was conducted on thirty septic patients at the Intensive Care Unit.

Measurement and result: Hemostatic parameters (prothrombin time [PT], activated partial thromboplastin time [aPTT], and international normalized ratio [INR]) and thromboelastography parameters (R time, K time, α angle, maximum amplitude [MA], G value, coagulation index [CI], and LY30) were analyzed using the normality test, homogeneity test, t-test, correlation test, and receiver operating characteristic (ROC) curve test in SPSS version 17.0. SOFA scores 8-11 and 12-20 had the highest mortality (100%). R time, K time, CI, α angle, MA, and G value, and all hemostatic parameters significantly correlated with SOFA score (p<0.05). R time, K time, α angle, CI, PT, aPTT, and INR of living patients significantly differed from death patients (p<0.001). K time, α angle, MA, CI, and all hemostatic parameters had an area under the curve (AUC) close to 1 (p<0.05). K time (69.2%) and aPTT (100%) had the highest sensitivity. The positive predictive value (PPV) of all TEG parameters was 100%. aPTT (100%) was the highest in the hemostatic parameters. The hemostatic parameters had a higher sensitivity than its specificity, while the TEG had higher specificity than its sensitivity.

Conclusion: Most thromboelastography parameters and all hemostatic parameters significantly correlated with the SOFA score. K time had the highest sensitivity and specificity as the diagnostic parameter of septic mortality compared to the other thromboelastography parameters, while aPTT was the most sensitive diagnostic parameter of septic mortality compared to other hemostatic parameters.