ABSTRACT
[Abstract] Objective To determine the prognostic value of thrombomodulin (TM) combined with thrombin-antithrombin complex (TAT) in patients with sepsis. Methods A retrospective analysis of the clinical data from 80 patients with sepsis who met the inclusion and exclusion criteria admitted to the 908th Hospital of Chinese PLA Logistical Support Force from May 2018 to July 2019. The conventional coagulation tests, thromboelastographic (TEG) parameters, TM, TAT, α2-plasmin inhibitor-plasmin complex (PIC, namely plasmin/alpha 2-antiplasmin complex, PAP) and tissue plasminogen activator-inhibitor-1 complex (t-PAIC) were collected within 2 hours at admission. According to the prognosis of 90 days, the patients were divided into survival group and death group and statistical analysis were performed. Results Compared with TM [11.7(8.8, 15.9) TU/ml] and TAT [11.3(7.0, 20.5) ng/ml] in the survival group, TM [20.2(14.1, 23.8) TU/ml] and TAT [17.7(11.8, 54.6) ng/ml] were significantly increased in the death group (P16.95 TU/ml combined with TAT>10.55 ng/ml. Conclusion TM combined with TAT can effectively judge the prognosis of sepsis patients and early identify sepsis related coagulation disorders.
ABSTRACT
Objective The platelet function changes are closely related to the prognosis of trauma patients and the occurrence of coagulopathy. The purpose of this paper is to investigate the clinical value of platelet function changes in trauma patients for prognosis judgment. Methods The clinical data of 94 trauma patients admitted to the Department of Critical Care Medicine, 908th Hospital from July 2017 to February 2019 were retrospectively analyzed. According to the 90-day prognosis of patients, the patients were divided into survival group (n=80) and death group (n=14) to compare the traditional coagulation function indexes, including prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), thrombin time (TT), fibrinogen degradation product (FDP), D-dimer, antithrombin II (I ATIII), thromboelastogram (TEG) index [coagulation reaction time (R), clot formation rate (K), clot formation kinetics (α angle), maximum clot strength (MA), etc.] and platelet aggregation function index [arachidonic acid (AA) platelet aggregation rate and adenosine diphosphate (ADP) Platelet aggregation rate]. The data was analyzed by receiver operating characteristic (ROC) curve analysis and Kaplan-Meier analysis. Results Compared with the survival group, the APPT, R value and K value prolonged significantly in the death group (P<0.05). However, the MA value，AA-induced and ADP-induced platelet aggregation decreased significantly in the death group (P<0.05). The ROC curve analysis showed that when the MA cut-off value was 42.05mm, the sensitivity, specificity, positive predictive value and negative predictive value were 83.8%, 71.4%, 58.3% and 94.2% respectively. When the cut-off value of AA platelet aggregation rate was 36.6%, the sensitivity, specificity, positive predictive value and negative predictive value were 57.5%, 85.7%, 75.5% and 93.8% respectively. When the cut-off value of ADP platelet aggregation rate was 29.3%, the sensitivity, specificity, positive predictive value and negative predictive value were 70%, 64.3%, 72.7% and 91.8% respectively. The death risk of patients with AA-induced aggregation rate < 36.6% was 4.37 times that of the patients with AA-induced platelet aggregation rate ≥ 36.6% (95% CI: 1.34 to 10.98). The death risk of patients with ADP-induced aggregation rate < 29.3% was 3.674 times that of the patients with ADP-induced platelet aggregation rate ≥ 29.3% (95%CI:1.385~ 12.880). The death risk of trauma patients with MA < 42.05 mm was 9.759 times that of the patients with MA ≥ 42.05 mm (95% CI: 6.674 ~ 89.87). Conclusion The platelet function of trauma patients can be significantly impaired. When the MA, AA platelet aggregation rate and ADP platelet aggregation rate are lower, the mortality rate of trauma patients becomes higher. The platelet function index of MA, AA and ADP can be used to determine the prognosis of trauma patients.
ABSTRACT
The clinical treatment of sepsis has always been a problem. Sepsis is characterized by high morbidity, high mortality and high treatment costs.Platelets were previously thought to play a major role in hemostasis and thrombosis.In recent years, it has been found that platelets are very important in inflammation and immune regulation as well as in hemostasis and thrombosis. Antiplatelet therapy can reduce release of inflammation and immunomodulatory mediators by attenuating platelet activation, thereby alleviating the inflammatory response in sepsis. This paper reviews the mechanism of platelet involvement in sepsis and the clinical progress of antiplatelet drugs in managing sepsis.
ABSTRACT
Objective According to the cell-based coagulation theory, antithrombin complex (TAT) reflecting the activation of coagulation system, plasmin-α2 anti-plasmin complex (PIC) reflecting the activation of fibrinolytic system, thrombomodulin (TM) and tissue plasminogen activator-plasminogen activator inhibitor-1 complex (t-PAIC) reflecting vascular endothelial function were selected to explore their diagnostic values for disseminated intravascular coagulation. Methods A prospective study was conducted on 154 patients in the Department of Critical Care Medicine of the 908th Hospital from May to December 2018. The subjects were divided into non-overt DIC group (n=134) and overt DIC group (n=20) according to the diagnostic criteria of International Thrombus and Hemostatic Association. The differences among groups of TM, t-PAIC, TAT and PIC were compared along with statistical analysis. Results Compared with TM [10.5 (8.0~14.3) TU/mL], TAT [9.6 (4.9~21.8) ng/mL], PIC [1.253 (0.789~2.802) μg/mL] and t-PAIC [ 11.2 (7.1~22.1) ng/mL] in non-overt DIC group, TM [16.8 (11.8~21.5) TU/mL], TAT [33.6 (10.3~120.0) ng/mL], PIC [4.080 (0.814~8.651) μg/mL] and t-PAIC [19.4 (10.0~30.1)ng/mL] ) in overt DIC group were significantly increased (P<0.05). The area under the curve of TM>14.85 TU/mL combined with TAT>23.05 ng/mL as the standard diagnostic overt DIC was 0.835 (P=0.000), and the sensitivity, specificity, positive predictive value and negative predictive value were 0.85, 0.761, 0.592, 0.925 respectively. Conclusion TM combined with TAT has a higher diagnostic efficacy for overt DIC.
ABSTRACT
Objective Bloodstream infection (BSI)-induced sepsis may cause severe coagulation dysfunction. In this study, we analyzed the characteristics of coagulation dysfunction in different phases of BSI-induced sepsis.Methods We retrospectively analyzed the clinical data on 43 cases of BSI treated in our Department of Critical Care Medicine from January 2016 to September 2018. According to the Diagnostic Criteria for Sepsis 3.0, we divided the patients into a sepsis group and a septic shock group, compared the traditional indexes of coagulation function and parameters of thromboelastography (TEG) between the two groups, and analyzed the obtained data with the ROC curves.Results Compared with the sepsis group, the septic shock group showed significantly prolonged prothrombin time (PT) (13.7 \[12.5-17.4] vs 16.7 \[15.0-20.9\] s, P0.05).Conclusion Coagulation dysfunction in BSI-induced sepsis is characterized by elevated values of DD and FDP, and in case of septic shock, it features low coagulation of clotting factors (R≥8.5 min) and fibrin function (K≥2.65 min). The patient with septic shock may experience significantly reduced PLT with basically normal platelet function.
ABSTRACT
Objective Coagulation disorder is an independent risk factor of death in trauma patients. This study aimed to investigate the prognostic value of thromboelastography (TEG) for patients with trauma-induced coagulopathy.Methods This retrospective study included 124 cases of trauma-induced coagulopathy treated in our Department of Critical Care Medicine from September 2015 to July 2018. We collected the clinical data and laboratory Results of the patients within 2 hours after admission, divided the patients into a survival group (n=108) and death group (n=16) according to their 90-day prognosis after trauma, and compared the TEG parameters between the two groups. Using logistic regression analysis and ROC curves, we identified the optimal prognostic factors and compared the platelet (PLT) count and mortality rate among those with different cut-off values.Results In comparison with the survival group, the death group showed a significant increase in the clot formation time (CFT) (3.2 \[2.2-4.8\] vs 5.2 \[5.0-9.8\] min, P45.65 mm (86 \[46-114\] vs 116 \[84-171\]×109/L, P<0.05), and mortality was remarkably higher in the former than in the latter group (31.8% vs 1.2%, P<0.05).Conclusion Among the TEG parameters, MA / maximal clot strength is a valuable indicator for the prognosis of trauma-induced coagulopathy, and MA<45.65 mm indicates early PLT dysfunction and poor prognosis.