Clinical study of thromboelastography for assessment of coagulation disorders in children with sepsis

Objective To study the clinical significance of thromboelastography (TEG) for determining the presence of coagulation disorders in septic children. Methods A total of 100 patients suffering from sepsis or severe sepsis in pediatric intensive care unit (PICU) of Shanghai Children’s Medical Center from February 2014 to January 2015 were recruited. TEG tests and conventional coagulation laboratory tests (CCTs) including platelet count, fibrinogen, prothrombin time (PT), activated partial thromboplastin time, D-dimers, and international normalized ratio (INR) were carried out in all patients at the primary diagnosis of sepsis.Another 25 healthy children taking physical examination were enrolled as control group. Rank Sum Test was used to detect the differences in coagulation markers and TEG between the groups and there was statistical significance when P<0.05. Receiver operating characteristic (ROC) curves were used to evaluate the roles of TEG and CCTs tests in this study. Results Of them, there were 56 patients with sepsis and 44 with severe sepsis. The male to female ratio was 63∶37, the median age was 11.5 (3.3-48) months, and 71% patients suffered from underlying disease. According to TEG, 72 patients had coagulation disorders, including 28 with hypercoagulation and 44 with hypocoagulation. CCTs tests showed 50 patients had coagulation disorders, including 29 with non-overt DIC and 21 with overt DIC. The rate of hypercoagulability was significantly higher in non-DIC group than in non-overt DIC group (46% vs. 17.2%, P=0.016). The rate of hypocoagulability was significantly higher in overt DIC group than in non-overt DIC group (100% vs. 44.8%, P<0.01). Patients with hypercoagulation disorders had significantly shorter R(coagulation reaction time) and K(coagulation formation time) and greater α(angle α), MA(maximal amplitude) and CI(comprehensive coagulation index) compared with control group (P<0.01). According to CCTs results, patients with hypercoagulation had significantly prolonged PT compared with control group (P=0.002). Compared with sepsis group, severe sepsis group had significantly prolonged R and K and lower α, MA and CI (P<0.01). ROC analysis demonstrated that area under the curve (AUC) of TEG and CCTs variables for diagnosis of severe sepsis were significantly greater than 0.5. Both variables of α (P=0.000 2) and K (P=0.004 1) had significantly greater AUCs compared with Fib. Conclusions There were 72% septic patients with coagulation disorders.The hypercoagulability occurred earlier in patients with sepsis and the hypocoagulability occurred later in patients with severe sepsis.The TEG may provide important information for clinicians to deal with coagulation disorders in septic children. Key words: Thromboelastography; Sepsis; Severe sepsis; Coagulation disorders; Pediatrics