Correlation analysis of coagulation disorders and the severity and outcome of pediatric sepsis: Thromboelastography method

Abstract

Objective To assess the association between coagulation disorders and the severity as well as the outcome of pediatric sepsis by thromboelastography(TEG) method. Methods Total of 62 patients suffering from sepsis or severe sepsis in PICU in our hospital from February 2014 to January 2015 were included in this study.All patients had routine blood tests, inflammatory biomarkers(CRP, PCT) tests, organ function parameters(ALT, TBiL, ALB, Cr, BUN, PaO2/FiO2) tests, lactic acid, classical coagulation laboratory test(platelets count, APTT, PT, INR, Fib, D-dimers) and TEG(R, K, α, MA, LY30, CI) everyday for the first 3 days of diagnosis of sepsis or severe sepsis(D1, D2, D3). (1)D1~3 TEG results between Sepsis and Severe sepsis groups were investigated; D1 inflammatory biomarkers and D1~3 critical scores between hypocoagulation and hypercoagulation groups were investigated.(2)D1 organ function parameters(ALT, TBiL, ALB, Cr, BUN, PaO2/FiO2)and D1~3Pediatric multiple organ dysfunction score(P-MODS) between hypocoagulation and hypercoagulation groups were investigated.(3)D1~3 TEG results between sepsis and severe sepsis groups were compared; Dependence of 28 day survival on normal or pathological D1CI, APTT, PT were evaluated using Kaplan-Meier plots and Log Rank test. Results (1)Coagulation disorders and the severity of sepsis: Compared with sepsis group(n=41), severe sepsis group(n=21) presented persistent hypocoagulability: D1~2R and D1, D3K were significantly prolonged, D1~3α, MA, CI were significantly reduced(P<0.05); Compared with hypercoagulation group(n=26), hypocoagulation group(n=16) had significantly higher D1PRISM Ⅲ scores(P<0.05), lower D1 neutrophils counts(P<0.05). (2)Coagulation disorders and multiple organ dysfunction syndrome: Compared with hypercoagulation group, hypocoagulation group had more severe organ dysfunctions: Cr, BUN, ALT were increased(P<0.05); higher D1 P-MODS scores(P<0.05)and D1~3 organ failure index(P<0.05)were found in hypocoagulation group.(3)Coagulation disorders and outcome of sepsis: hypocoagulation group had a higher mortality than hypercoagulation group(62.5% vs.15.4%, P<0.05); Non-survival group(n=18) presented persistent hypocoagulability compared with survival group(n=44) according to D1~3TEG results[D1~2R, D1 and D3K were prolonged, D1~3α, MA, CI were reduced(P<0.05)]; Kaplan-Meier plots demonstrated that normal or pathological D1CI were associated with 28-day survival(P<0.05). Conclusion TEG assays present that persistent hypocoagulability can reveal the severity and 28 day prognosis of sepsis.TEG may be a valuable tool in assessing whole blood coagulation disorders in pediatric sepsis with a comprehensive evaluation of the severity as well as the outcome of sepsis. Key words: Thromboelastography; Sepsis; Severe sepsis; Coagulation disorders; Organ dysfunctions; Pediatrics