Thromboelastography in patients with severe sepsis: a prospective cohort study
Purpose To investigate the association between consecutively measured thromboelastographic (TEG) tracings and outcome in patients with severe sepsis. Methods Multicentre prospective observational study in a subgroup of the Scandinavian Starch for Severe Sepsis/Septic Shock (6S) Trial (NCT00962156) c...
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| Veröffentlicht in: | Intensive care medicine 2015-01, Vol.41 (1), p.77-85 |
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| creator | Haase, Nicolai Ostrowski, Sisse Rye Wetterslev, Jørn Lange, Theis Møller, Morten Hylander Tousi, Hamid Steensen, Morten Pott, Frank Søe-Jensen, Peter Nielsen, Jonas Hjortrup, Peter Buhl Johansson, Pär Ingemar Perner, Anders |
| description | Purpose
To investigate the association between consecutively measured thromboelastographic (TEG) tracings and outcome in patients with severe sepsis.
Methods
Multicentre prospective observational study in a subgroup of the Scandinavian Starch for Severe Sepsis/Septic Shock (6S) Trial (NCT00962156) comparing hydroxyethyl starch (HES) 130/0.42 vs. Ringer’s acetate for fluid resuscitation in severe sepsis. TEG (standard and functional fibrinogen) was measured consecutively for 5 days, and clinical data including bleeding and death was retrieved from the trial database. Statistical analyses included Cox regression with time-dependent covariates and joint modelling techniques.
Results
Of 267 eligible patients, we analysed 260 patients with TEG data. At 90 days, 68 (26 %) had bled and 139 (53 %) had died. For all TEG variables, hypocoagulability according to the reference range was significantly associated with increased risk of death. In a linear model, hazard ratios for death were 6.03 (95 % confidence interval, 1.64–22.17) for increased clot formation speed, 1.10 (1.04–1.16) for decreased angle, 1.09 (1.05–1.14) for decreased clot strength and 1.12 (1.06–1.18) for decreased fibrinogen contribution to clot strength (functional fibrinogen MA), showing that deterioration towards hypocoagulability in any TEG variable significantly increased the risk of death. Patients treated with HES had lower functional fibrinogen MA than those treated Ringer’s acetate, which significantly increased the risk of subsequent bleeding [HR 2.43 (1.16–5.07)] and possibly explained the excess bleeding with HES in the 6S trial.
Conclusions
In our cohort of patients with severe sepsis, progressive hypocoagulability defined by TEG variables was associated with increased risk of death and increased risk of bleeding. |
| doi_str_mv | 10.1007/s00134-014-3552-9 |
| format | Article |
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To investigate the association between consecutively measured thromboelastographic (TEG) tracings and outcome in patients with severe sepsis.
Methods
Multicentre prospective observational study in a subgroup of the Scandinavian Starch for Severe Sepsis/Septic Shock (6S) Trial (NCT00962156) comparing hydroxyethyl starch (HES) 130/0.42 vs. Ringer’s acetate for fluid resuscitation in severe sepsis. TEG (standard and functional fibrinogen) was measured consecutively for 5 days, and clinical data including bleeding and death was retrieved from the trial database. Statistical analyses included Cox regression with time-dependent covariates and joint modelling techniques.
Results
Of 267 eligible patients, we analysed 260 patients with TEG data. At 90 days, 68 (26 %) had bled and 139 (53 %) had died. For all TEG variables, hypocoagulability according to the reference range was significantly associated with increased risk of death. In a linear model, hazard ratios for death were 6.03 (95 % confidence interval, 1.64–22.17) for increased clot formation speed, 1.10 (1.04–1.16) for decreased angle, 1.09 (1.05–1.14) for decreased clot strength and 1.12 (1.06–1.18) for decreased fibrinogen contribution to clot strength (functional fibrinogen MA), showing that deterioration towards hypocoagulability in any TEG variable significantly increased the risk of death. Patients treated with HES had lower functional fibrinogen MA than those treated Ringer’s acetate, which significantly increased the risk of subsequent bleeding [HR 2.43 (1.16–5.07)] and possibly explained the excess bleeding with HES in the 6S trial.
Conclusions
In our cohort of patients with severe sepsis, progressive hypocoagulability defined by TEG variables was associated with increased risk of death and increased risk of bleeding.</description><identifier>ISSN: 0342-4642</identifier><identifier>EISSN: 1432-1238</identifier><identifier>DOI: 10.1007/s00134-014-3552-9</identifier><identifier>PMID: 25413378</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Acetates ; Aged ; Analysis ; Anesthesiology ; Blood Coagulation Disorders - diagnosis ; Blood Coagulation Disorders - etiology ; Care and treatment ; Clinical trials ; Cohort analysis ; Critical Care Medicine ; Disease Progression ; Emergency Medicine ; Female ; Fibrin ; Fibrinogen ; Fluid Therapy ; Humans ; Hydroxyethyl Starch Derivatives - therapeutic use ; Infection ; Intensive ; Intensive care ; Male ; Medical research ; Medicine ; Medicine & Public Health ; Medicine, Experimental ; Middle Aged ; Mortality ; Observational studies ; Original ; Pain Medicine ; Pediatrics ; Plasma Substitutes - therapeutic use ; Pneumology/Respiratory System ; Prospective Studies ; Resuscitation - methods ; Sepsis ; Sepsis - blood ; Sepsis - complications ; Sepsis - therapy ; Shock ; Thrombelastography ; Variables ; Viscoelasticity</subject><ispartof>Intensive care medicine, 2015-01, Vol.41 (1), p.77-85</ispartof><rights>Springer-Verlag Berlin Heidelberg and ESICM 2014</rights><rights>COPYRIGHT 2015 Springer</rights><rights>Springer-Verlag Berlin Heidelberg and ESICM 2015</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c543t-8437c5d703cd84ab9ac13915289bce255696d0f759a9a2d99461d42aae208cf83</citedby><cites>FETCH-LOGICAL-c543t-8437c5d703cd84ab9ac13915289bce255696d0f759a9a2d99461d42aae208cf83</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00134-014-3552-9$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00134-014-3552-9$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25413378$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Haase, Nicolai</creatorcontrib><creatorcontrib>Ostrowski, Sisse Rye</creatorcontrib><creatorcontrib>Wetterslev, Jørn</creatorcontrib><creatorcontrib>Lange, Theis</creatorcontrib><creatorcontrib>Møller, Morten Hylander</creatorcontrib><creatorcontrib>Tousi, Hamid</creatorcontrib><creatorcontrib>Steensen, Morten</creatorcontrib><creatorcontrib>Pott, Frank</creatorcontrib><creatorcontrib>Søe-Jensen, Peter</creatorcontrib><creatorcontrib>Nielsen, Jonas</creatorcontrib><creatorcontrib>Hjortrup, Peter Buhl</creatorcontrib><creatorcontrib>Johansson, Pär Ingemar</creatorcontrib><creatorcontrib>Perner, Anders</creatorcontrib><title>Thromboelastography in patients with severe sepsis: a prospective cohort study</title><title>Intensive care medicine</title><addtitle>Intensive Care Med</addtitle><addtitle>Intensive Care Med</addtitle><description>Purpose
To investigate the association between consecutively measured thromboelastographic (TEG) tracings and outcome in patients with severe sepsis.
Methods
Multicentre prospective observational study in a subgroup of the Scandinavian Starch for Severe Sepsis/Septic Shock (6S) Trial (NCT00962156) comparing hydroxyethyl starch (HES) 130/0.42 vs. Ringer’s acetate for fluid resuscitation in severe sepsis. TEG (standard and functional fibrinogen) was measured consecutively for 5 days, and clinical data including bleeding and death was retrieved from the trial database. Statistical analyses included Cox regression with time-dependent covariates and joint modelling techniques.
Results
Of 267 eligible patients, we analysed 260 patients with TEG data. At 90 days, 68 (26 %) had bled and 139 (53 %) had died. For all TEG variables, hypocoagulability according to the reference range was significantly associated with increased risk of death. In a linear model, hazard ratios for death were 6.03 (95 % confidence interval, 1.64–22.17) for increased clot formation speed, 1.10 (1.04–1.16) for decreased angle, 1.09 (1.05–1.14) for decreased clot strength and 1.12 (1.06–1.18) for decreased fibrinogen contribution to clot strength (functional fibrinogen MA), showing that deterioration towards hypocoagulability in any TEG variable significantly increased the risk of death. Patients treated with HES had lower functional fibrinogen MA than those treated Ringer’s acetate, which significantly increased the risk of subsequent bleeding [HR 2.43 (1.16–5.07)] and possibly explained the excess bleeding with HES in the 6S trial.
Conclusions
In our cohort of patients with severe sepsis, progressive hypocoagulability defined by TEG variables was associated with increased risk of death and increased risk of bleeding.</description><subject>Acetates</subject><subject>Aged</subject><subject>Analysis</subject><subject>Anesthesiology</subject><subject>Blood Coagulation Disorders - diagnosis</subject><subject>Blood Coagulation Disorders - etiology</subject><subject>Care and treatment</subject><subject>Clinical trials</subject><subject>Cohort analysis</subject><subject>Critical Care Medicine</subject><subject>Disease Progression</subject><subject>Emergency Medicine</subject><subject>Female</subject><subject>Fibrin</subject><subject>Fibrinogen</subject><subject>Fluid Therapy</subject><subject>Humans</subject><subject>Hydroxyethyl Starch Derivatives - therapeutic use</subject><subject>Infection</subject><subject>Intensive</subject><subject>Intensive care</subject><subject>Male</subject><subject>Medical research</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Medicine, Experimental</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Observational studies</subject><subject>Original</subject><subject>Pain Medicine</subject><subject>Pediatrics</subject><subject>Plasma Substitutes - therapeutic use</subject><subject>Pneumology/Respiratory System</subject><subject>Prospective Studies</subject><subject>Resuscitation - methods</subject><subject>Sepsis</subject><subject>Sepsis - blood</subject><subject>Sepsis - complications</subject><subject>Sepsis - therapy</subject><subject>Shock</subject><subject>Thrombelastography</subject><subject>Variables</subject><subject>Viscoelasticity</subject><issn>0342-4642</issn><issn>1432-1238</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqNkl1rFDEUhoModq3-AG9kwBtvUvM9iXel-AXF3tTrkM2c2U2ZmYxJprL_3ixbW5UVSi4O5DzvyznJi9BrSs4oIe37TAjlAhMqMJeSYfMErajgDFPG9VO0IlwwLJRgJ-hFzjeVbpWkz9EJk4Jy3uoV-na9TXFcRxhcLnGT3LzdNWFqZlcCTCU3P0PZNhluIUEtcw75Q-OaOcU8gy_hFhoftzGVJpel271Ez3o3ZHh1V0_R908fry--4Murz18vzi-xl4IXrAVvvexawn2nhVsb5yk3VDJt1h6YlMqojvStNM441hkjFO0Ecw4Y0b7X_BS9O_jWQX4skIsdQ_YwDG6CuGRLlRRKaa7oI1DeSqUIIRV9-w96E5c01UX2lBRECaofqI0bwIapjyU5vze15y0TzEhDVKXwEWoDEyQ3xAn6UK__4s-O8PV0MAZ_VEAPAl__Iifo7ZzC6NLOUmL38bCHeNgaD7uPhzVV8-ZuwWU9Qnev-J2HCrADkGtr2kD64wX-6_oLv7TB7A</recordid><startdate>20150101</startdate><enddate>20150101</enddate><creator>Haase, Nicolai</creator><creator>Ostrowski, Sisse Rye</creator><creator>Wetterslev, Jørn</creator><creator>Lange, Theis</creator><creator>Møller, Morten Hylander</creator><creator>Tousi, Hamid</creator><creator>Steensen, Morten</creator><creator>Pott, Frank</creator><creator>Søe-Jensen, Peter</creator><creator>Nielsen, Jonas</creator><creator>Hjortrup, Peter Buhl</creator><creator>Johansson, Pär Ingemar</creator><creator>Perner, Anders</creator><general>Springer Berlin Heidelberg</general><general>Springer</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M7Z</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>7QL</scope><scope>7U1</scope><scope>7U2</scope><scope>C1K</scope></search><sort><creationdate>20150101</creationdate><title>Thromboelastography in patients with severe sepsis: a prospective cohort study</title><author>Haase, Nicolai ; Ostrowski, Sisse Rye ; Wetterslev, Jørn ; Lange, Theis ; Møller, Morten Hylander ; Tousi, Hamid ; Steensen, Morten ; Pott, Frank ; Søe-Jensen, Peter ; Nielsen, Jonas ; Hjortrup, Peter Buhl ; Johansson, Pär Ingemar ; Perner, Anders</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c543t-8437c5d703cd84ab9ac13915289bce255696d0f759a9a2d99461d42aae208cf83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Acetates</topic><topic>Aged</topic><topic>Analysis</topic><topic>Anesthesiology</topic><topic>Blood Coagulation Disorders - diagnosis</topic><topic>Blood Coagulation Disorders - etiology</topic><topic>Care and treatment</topic><topic>Clinical trials</topic><topic>Cohort analysis</topic><topic>Critical Care Medicine</topic><topic>Disease Progression</topic><topic>Emergency Medicine</topic><topic>Female</topic><topic>Fibrin</topic><topic>Fibrinogen</topic><topic>Fluid Therapy</topic><topic>Humans</topic><topic>Hydroxyethyl Starch Derivatives - therapeutic use</topic><topic>Infection</topic><topic>Intensive</topic><topic>Intensive care</topic><topic>Male</topic><topic>Medical research</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Medicine, Experimental</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Observational studies</topic><topic>Original</topic><topic>Pain Medicine</topic><topic>Pediatrics</topic><topic>Plasma Substitutes - therapeutic use</topic><topic>Pneumology/Respiratory System</topic><topic>Prospective Studies</topic><topic>Resuscitation - methods</topic><topic>Sepsis</topic><topic>Sepsis - blood</topic><topic>Sepsis - complications</topic><topic>Sepsis - therapy</topic><topic>Shock</topic><topic>Thrombelastography</topic><topic>Variables</topic><topic>Viscoelasticity</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Haase, Nicolai</creatorcontrib><creatorcontrib>Ostrowski, Sisse Rye</creatorcontrib><creatorcontrib>Wetterslev, Jørn</creatorcontrib><creatorcontrib>Lange, Theis</creatorcontrib><creatorcontrib>Møller, Morten Hylander</creatorcontrib><creatorcontrib>Tousi, Hamid</creatorcontrib><creatorcontrib>Steensen, Morten</creatorcontrib><creatorcontrib>Pott, Frank</creatorcontrib><creatorcontrib>Søe-Jensen, Peter</creatorcontrib><creatorcontrib>Nielsen, Jonas</creatorcontrib><creatorcontrib>Hjortrup, Peter Buhl</creatorcontrib><creatorcontrib>Johansson, Pär Ingemar</creatorcontrib><creatorcontrib>Perner, Anders</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biochemistry Abstracts 1</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Risk Abstracts</collection><collection>Safety Science and Risk</collection><collection>Environmental Sciences and Pollution Management</collection><jtitle>Intensive care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Haase, Nicolai</au><au>Ostrowski, Sisse Rye</au><au>Wetterslev, Jørn</au><au>Lange, Theis</au><au>Møller, Morten Hylander</au><au>Tousi, Hamid</au><au>Steensen, Morten</au><au>Pott, Frank</au><au>Søe-Jensen, Peter</au><au>Nielsen, Jonas</au><au>Hjortrup, Peter Buhl</au><au>Johansson, Pär Ingemar</au><au>Perner, Anders</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Thromboelastography in patients with severe sepsis: a prospective cohort study</atitle><jtitle>Intensive care medicine</jtitle><stitle>Intensive Care Med</stitle><addtitle>Intensive Care Med</addtitle><date>2015-01-01</date><risdate>2015</risdate><volume>41</volume><issue>1</issue><spage>77</spage><epage>85</epage><pages>77-85</pages><issn>0342-4642</issn><eissn>1432-1238</eissn><abstract>Purpose
To investigate the association between consecutively measured thromboelastographic (TEG) tracings and outcome in patients with severe sepsis.
Methods
Multicentre prospective observational study in a subgroup of the Scandinavian Starch for Severe Sepsis/Septic Shock (6S) Trial (NCT00962156) comparing hydroxyethyl starch (HES) 130/0.42 vs. Ringer’s acetate for fluid resuscitation in severe sepsis. TEG (standard and functional fibrinogen) was measured consecutively for 5 days, and clinical data including bleeding and death was retrieved from the trial database. Statistical analyses included Cox regression with time-dependent covariates and joint modelling techniques.
Results
Of 267 eligible patients, we analysed 260 patients with TEG data. At 90 days, 68 (26 %) had bled and 139 (53 %) had died. For all TEG variables, hypocoagulability according to the reference range was significantly associated with increased risk of death. In a linear model, hazard ratios for death were 6.03 (95 % confidence interval, 1.64–22.17) for increased clot formation speed, 1.10 (1.04–1.16) for decreased angle, 1.09 (1.05–1.14) for decreased clot strength and 1.12 (1.06–1.18) for decreased fibrinogen contribution to clot strength (functional fibrinogen MA), showing that deterioration towards hypocoagulability in any TEG variable significantly increased the risk of death. Patients treated with HES had lower functional fibrinogen MA than those treated Ringer’s acetate, which significantly increased the risk of subsequent bleeding [HR 2.43 (1.16–5.07)] and possibly explained the excess bleeding with HES in the 6S trial.
Conclusions
In our cohort of patients with severe sepsis, progressive hypocoagulability defined by TEG variables was associated with increased risk of death and increased risk of bleeding.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>25413378</pmid><doi>10.1007/s00134-014-3552-9</doi><tpages>9</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0342-4642 |
| ispartof | Intensive care medicine, 2015-01, Vol.41 (1), p.77-85 |
| issn | 0342-4642 1432-1238 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1654668361 |
| source | MEDLINE; SpringerNature Journals |
| subjects | Acetates Aged Analysis Anesthesiology Blood Coagulation Disorders - diagnosis Blood Coagulation Disorders - etiology Care and treatment Clinical trials Cohort analysis Critical Care Medicine Disease Progression Emergency Medicine Female Fibrin Fibrinogen Fluid Therapy Humans Hydroxyethyl Starch Derivatives - therapeutic use Infection Intensive Intensive care Male Medical research Medicine Medicine & Public Health Medicine, Experimental Middle Aged Mortality Observational studies Original Pain Medicine Pediatrics Plasma Substitutes - therapeutic use Pneumology/Respiratory System Prospective Studies Resuscitation - methods Sepsis Sepsis - blood Sepsis - complications Sepsis - therapy Shock Thrombelastography Variables Viscoelasticity |
| title | Thromboelastography in patients with severe sepsis: a prospective cohort study |
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