Viscoelastic and aggregometric point-of-care testing in patients with septic shock - cross-links between inflammation and haemostasis.
Summary of "Viscoelastic and aggregometric point-of-care testing in patients with septic shock - cross-links between inflammation and haemostasis."
BACKGROUND:
In the pathogenesis of sepsis, inflammation-induced changes in coagulation play a pivotal role.
METHODS:
In total, 90 patients (30 patients with septic shock, 30 surgical patients following major abdominal surgery and 30 healthy volunteers) were enrolled. Blood samples from patients with septic shock were collected at the time of sepsis diagnosis as well as 24 h, 4 days, 7 days, 14 days and 28 days later. Samples from surgical patients with a post-surgical inflammatory response were collected three times (before surgery, immediately after surgery and 24 h after surgery) and once from healthy volunteers. Thromboelastometry (ROTEM (®) ), as well as whole blood impedance aggregometry (Multiplate(®) ) were performed. Additionally, plasma concentrations of interleukin-6 and tumour necrosis factor-alpha were measured using enzyme-linked immunosorbent assay kits.
RESULTS:
Thromboelastometry lysis index was shown to be a reliable biomarker for septic shock. Furthermore, in septic patients with overt disseminated intravascular coagulation, thromboelastometry revealed signs indicating a hypocoagulable status, whereas patients without overt disseminated intravascular coagulation were found to be hypercoagulable. Platelet aggregation capability, as assessed by whole blood impedance aggregometry, was significantly reduced in septic patients with overt disseminated intravascular coagulation, whereas it was comparable with healthy volunteers and in septic patients without overt disseminated intravascular coagulation.
CONCLUSION:
Viscoelastic and aggregometric point-of-care testing was shown to be potentially useful for bedside diagnosis of sepsis. Moreover, viscoelastic and aggregometric point-of-care testing was able to determine the phase of septic coagulopathy (hypercoagulability vs. hypocoagulability) and therefore identified patients at high risk for overt disseminated intravascular coagulation.
Affiliation
Department of Anaesthesiology, University of Heidelberg, Heidelberg, Germany.
Journal Details
This article was published in the following journal.
Name: Acta anaesthesiologica Scandinavica
ISSN: 1399-6576
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/22897591
- DOI: http://dx.doi.org/10.1111/j.1399-6576.2012.02750.x
Medical and Biotech [MESH] Definitions
Point-of-care Systems
Laboratory and other services provided to patients at the bedside. These include diagnostic and laboratory testing using automated information entry.
Physicians, Primary Care
Providers of initial care for patients. These PHYSICIANS refer patients when appropriate for secondary or specialist care.
Day Care
Institutional health care of patients during the day. The patients return home at night.
Evidence-based Medicine
An approach of practicing medicine with the goal to improve and evaluate patient care. It requires the judicious integration of best research evidence with the patient's values to make decisions about medical care. This method is to help physicians make proper diagnosis, devise best testing plan, choose best treatment and methods of disease prevention, as well as develop guidelines for large groups of patients with the same disease. (from JAMA 296 (9), 2006)
Patient Admission
The process of accepting patients. The concept includes patients accepted for medical and nursing care in a hospital or other health care institution.
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