Critical Care and Shock

Diagnostic value of thromboelastography parameters on sepsis-induced coagulopathy in patients with sepsis in Intensive Care Unit, Dr. Hasan Sadikin General Hospital Bandung

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Abstract

Objective: Sepsis is related to impaired hemostasis, starting with a subclinical coagulation activation known as hypercoagulability. The term for the coagulopathy process that occurs during the pathogenesis of sepsis is sepsis-induced coagulopathy (SIC). Appropriate information can be obtained using thromboelastography (TEG) to identify hemostatic disorders. This study aimed to assess the TEG parameter’s diagnostic value for SIC in septic patients.

Design: An analytical observational study with a cross-sectional design was conducted on septic patients treated in the Intensive Care Unit (ICU) of Dr. Hasan Sadikin General Hospital Bandung. TEG examinations were performed with TEG® 5000 Thrombelastograph® Hemostasis Analyzer. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic result’s accuracy and to calculate the discriminatory value of the area under the curve (AUC).

Setting: Dr. Hasan Sadikin General Hospital Bandung.

Patients and participants: The participants were patients aged between 18-65 years old, treated in the ICU, with a diagnosis of sepsis established with Sequential Organ Failure Assessment (SOFA) score criteria. The minimum sample size was calculated with a one-sample sensitivity-based formula with type 1 error or α set at 10%, type 2 or β error set at 20%, resulting in a minimum sample size of 35 patients.

Results: It was revealed that patients with SIC had higher abnormal mean parameter TEG and SOFA scores than patients without SIC (p<0.001). α angle sensitivity was 85.7% with a specificity of 78.6%, while maximum amplitude (MA) had a sensitivity of 80.9% with a specificity of 78.6%. The coagulation index (CI) was 90.5% sensitive and 85.7% specific. The AUC diagnosis value of CI and MA was 0.876 and 0.886, respectively.

Conclusion: It is concluded that TEG parameters had an average to strong diagnostic value for SIC and could be used as routine examination for intervention in septic patients.