Presentation Details
| Thromboelastometry (TEG): Utility in diagnosing of infection in Neurosurgery Intensive care unit (ICU) as compared to established biomarkers Renu Rani, Deepak Agarwal. AIIMS, New Delhi, India |
Abstract
Introduction: Infection is a common cause of death in critically ill patients, and early diagnosis is mandatory to improve the prognosis. Established biomarkers for the diagnosis of sepsis are procalcitonin, interleukin 6, and C-reactive protein. However, the changes of coagulation and activation of hemostasis are marked of pathophysiologic relevance to the infection, and associated with increased mortality. These alterations can detect by thromboelastometry. AIMS: We investigated whether thromboelastometry variables can be used for the early detection of infection in Neurosurgery Intensive care unit (ICU) as compare to established biomarker. Methods: In the observational cohort study, blood samples were obtained from patients who admitted to the neurosurgery ICU on admission day 0 and subsequently samples were collected at day 3 and day 5. Later on patients were classified into two groups, who developed infection at day 3 (n=60) and who did not developed infection till day 5 (n = 40). TEG variables such as clotting time, clot formation time, maximum clot firmness, alpha angle, and lysis index were measured with thromboelastometry at the all three time points for both the groups. In addition, procalcitonin, interleukin 6, and C-reactive protein levels will also be determined simultaneously at all three points for comparison. Baseline characteristics, demographic data, biochemical parameters were obtained at the time of inclusion. Results: In comparison with noninfectious group, patients with infection showed significantly prolong (71.7% p=0.00) clot-formation time (R time) on the admission (Day0). Similar observations were obtained with the clotting time (k time), value was significantly prolong in the infectious group (41.7% p=0.05) on the admission. Alpha angle was not significantly different between groups , but the maximum clot firmness (MA) was slightly prolonged at day 5 (75%, p=0.03). Infection detection capability goes 9.3 (95% CI 1.5-57.6, p=0.01) time higher when three variables Clot-formation time (R time), clotting time (k time) and maximum clot firmness (MA) with abnormal value were combined on admission day and day5 respectively. Procalcitonin, interleukin 6, and C-reactive protein concentrations were tested for differences between patients with and without infection at different time of interval (Day0, day3, and day5). Conclusions: The thromboelastometry clot-formation time (R time) proved to be a more reliable biomarker of severe sepsis in critically ill adults than were procalcitonin, interleukin 6, and C-reactive protein. The results also demonstrate that early involvement of the hemostatic system is a common event in infection.
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No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.