Utility of thromboelastography and/or thromboelastometry in adults with sepsis: a systematic review
Open Access
- 10 February 2014
- journal article
- review article
- Published by Springer Science and Business Media LLC in Critical Care
- Vol. 18 (1), R30-11
- https://doi.org/10.1186/cc13721
Abstract
Coagulation abnormalities are frequent in sepsis. Conventional coagulation assays, however, have several limitations. A surge of interest exists in the use of point-of-care tests to diagnose hypo- and hypercoagulability in sepsis. We performed a systematic review of available literature to establish the value of rotational thromboelastography (TEG) and thromboelastometry (ROTEM) compared with standard coagulation tests to detect hyper- or hypocoagulability in sepsis patients. Furthermore, we assessed the value of TEG/ROTEM to identify sepsis patients likely to benefit from therapies that interfere with the coagulation system. MEDLINE, EMBASE, and the Cochrane Library were searched from 1 January 1980 to 31 December 2012. The search was limited to adults, and language was limited to English. Reference lists of retrieved articles were hand-searched for additional studies. Ongoing trials were searched on http://www.controlled-trials.com and http://www.clinicaltrials.gov. Studies addressing TEG/ROTEM measurements in adult patients with sepsis admitted to the ICU were considered eligible. Of 680 screened articles, 18 studies were included, of which two were randomized controlled trials, and 16 were observational cohort studies. In patients with sepsis, results show both hyper- and hypocoagulability, as well as TEG/ROTEM values that fell within reference values. Both hyper- and hypocoagulability were to some extent associated with diffuse intravascular coagulation. Compared with conventional coagulation tests, TEG/ROTEM can detect impaired fibrinolysis, which can possibly help to discriminate between sepsis and systemic inflammatory response syndrome (SIRS). A hypocoagulable profile is associated with increased mortality. The value of TEG/ROTEM to identify patients with sepsis who could possibly benefit from therapies interfering with the coagulation system could not be assessed, because studies addressing this topic were limited. TEG/ROTEM could be a promising tool in diagnosing alterations in coagulation in sepsis. Further research on the value of TEG/ROTEM in these patients is warranted. Given that coagulopathy is a dynamic process, sequential measurements are needed to understand the coagulation patterns in sepsis, as can be detected by TEG/ROTEM.Keywords
This publication has 61 references indexed in Scilit:
- Viscoelastic and aggregometric point‐of‐care testing in patients with septic shock – cross‐links between inflammation and haemostasisActa Anaesthesiologica Scandinavica, 2012
- Early diagnostic markers of sepsis after oesophagectomy (including thromboelastography)BMC Anesthesiology, 2012
- QUADAS-2: A Revised Tool for the Quality Assessment of Diagnostic Accuracy StudiesAnnals of Internal Medicine, 2011
- Dobutamine administration in patients after cardiac surgery: beneficial or harmful?Critical Care, 2011
- Real-time ultrasound-guided percutaneous dilatational tracheostomyCritical Care, 2011
- Elevated Cardiac Troponin I in Sepsis and Septic Shock: No Evidence for Thrombus Associated Myocardial NecrosisPLOS ONE, 2010
- Comparison of thrombelastometry with procalcitonin, interleukin 6, and C-reactive protein as diagnostic tests for severe sepsis in critical ill adultsCritical Care, 2010
- Thromboelastometry for the assessment of coagulation abnormalities in early and established adult sepsis: a prospective cohort studyCritical Care, 2009
- Antithrombin III in critically ill patients: systematic review with meta-analysis and trial sequential analysisBMJ, 2007
- Definitions for Sepsis and Organ Failure and Guidelines for the Use of Innovative Therapies in SepsisSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 1992