Are thromboelastometric and thromboelastographic parameters associated with mortality in septic patients? A systematic review and meta-analysis.
Boscolo, Annalisa MD a, *; Spiezia, Luca MD b; De Cassai, Alessandro MD a; Pasin, Laura MD a; Pesenti, Elisa MD c; Zatta, Matteo MD c; Zampirollo, Stefano MD c; Andreatta, Giulio MD c; Sella, Nicolo c; Pettenuzzo, Tommaso a; Rose, Kirstin MD d; Simioni, Paolo b; Navalesi, Paolo a, c
[Article]
Journal of Critical Care.
61:5-13, February 2021.
(Format: HTML, PDF)
Background: Thromboelastometry/elastography (ROTEM/TEG) showed promising results for diagnosis of sepsis-induced coagulopathy, but their association with the outcome is unclear. Our aim was to assess any difference in ROTEM/TEG measurements between septic survivors and non-survivors.
Methods: Pubmed, Web of Science, Embase and Cochrane Library databases were investigated. The research aimed to include any randomized or observational study: i) on septic adult patients admitted to Intensive Care Unit (ICU) or Emergency Department (ED); ii) including ROTEM/TEG; iii) assessing mortality.
Results: Seven prospective and four retrospective observational studies (952 patients) were included. According to the INTEM/kaolin-assay, clotting time (CT)/R (standardized mean difference(SMD) -0.29, 95% CI -0.49 to -0.09, p = 0.004) and clot formation time (CFT)/K (SMD -0.42, 95% CI -0.78 to -0.06, p = 0.02) were shorter in survivors. According to the EXTEM-assay, CT was shorter (MD -11.66 s, 95% CI -22.59 to -0.73, p = 0.04), while MCF was higher (MD 3.49 mm, 95% CI 0.43 to 6.55, p = 0.03) in survivors. A hypocoagulable profile was more frequent in non-survivors (OR 0.31, 95%CI 0.18 to 0.55, p < 0.0001). Overall, the risk of bias of the included studies was moderate and the quality of evidence low.
Conclusions: Hypocoagulability and lower MCF in EXTEM may be associated with higher mortality in sepsis.
Highligths:
* Thromboelastometry/elastography (ROTEM/TEG) important point-of-care tests to identify septic coagulative disorders.
* Hypocoagulable profiles and lower MCF in the EXTEM-assay may be associated with higher mortality in sepsis.
(C) 2021Elsevier, Inc.