Effect of hypofibrinolysis on clinical outcomes of patients with septic disseminated intravascular coagulation

IF 3.7 3区医学 Q1 HEMATOLOGY

Thrombosis research Pub Date : 2025-01-01 DOI:10.1016/j.thromres.2024.109235

Hiroyuki Koami, Yuichiro Sakamoto, Yuri Hirota, Akira Sasaki, Hirotaka Ogawa, Yutaro Furukawa, Ayaka Matsuoka, Kota Shinada, Kento Nakayama, Ryota Sakurai, Sachiko Iwanaga, Takayuki Onohara, Shogo Narumi, Mayuko Koba

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引用次数: 0

Abstract

Background

This study investigated the utility of thromboelastometry (ROTEM) in assessing hypofibrinolysis among septic patients, specifically the association of hypofibrinolysis, as determined by ROTEM, with septic disseminated intravascular coagulation (DIC), organ dysfunction, and clinical outcomes.

Methods

This single-center, retrospective analysis included adult septic patients admitted to Saga University Hospital from 2013 to 2017, with available ROTEM data. Hypofibrinolysis was assessed using the lysis index at 60 min (LI60) in extrinsic thromboelastometry (EXTEM). Based on their LI60 values, patients were classified into three groups: Hyper (LI60 ≤ 85), Normal (LI60 86–96), and Hypo (LI60 ≥ 97).

Results

Among the 63 cases analyzed, the Hypo group showed significantly higher APACHEII and SOFA scores than the Normal group, indicating greater disease severity. Similarly, DIC and sepsis-induced coagulopathy (SIC) scores were notably higher in the Hypo group. The diagnostic performance of LI60 for ISTH-overt DIC showed an area under the curve (AUC) of 0.954, with an optimal cutoff value of 97 %, achieving 100 % sensitivity and 83.3 % specificity. The odds ratio for ISTH-overt DIC was 2.894, indicating a strong association between elevated LI60 and occurrence of DIC. Hypofibrinolysis predicted 28-day mortality and high SOFA scores (≥ 10) with high specificity and negative predictive value (NPV). A Kaplan-Meier curve revealed that the Hypo Group showed significantly worse clinical outcomes than the Normal and Hyper groups.

Conclusion

For septic patients, fibrinolysis suppression presenting as “hypofibrinolysis” (elevated LI60) is associated with poor prognosis and risk of higher organ dysfunction. Moreover, it is a significant predictor of adverse clinical outcomes in sepsis.

查看原文本刊更多论文

低纤溶对脓毒性弥散性血管内凝血患者临床结局的影响。

背景：本研究调查了血栓弹性测量（ROTEM）在评估脓毒症患者低纤溶的效用，特别是由ROTEM测定的低纤溶与脓毒症弥散性血管内凝血（DIC）、器官功能障碍和临床结果的关系。方法：本研究采用单中心、回顾性分析，纳入2013年至2017年在佐贺大学医院住院的成年脓毒症患者，并提供ROTEM数据。采用外源性血栓弹性测定法（EXTEM） 60分钟溶栓指数（LI60）评估低纤溶。根据LI60值将患者分为高（LI60≤85）、正常（LI60 86 ~ 96）、低（LI60≥97）三组。结果：在分析的63例病例中，Hypo组APACHEII和SOFA评分明显高于Normal组，表明疾病严重程度更高。同样，Hypo组DIC和脓毒症诱导的凝血功能（SIC）评分明显较高。LI60对isth显性DIC的诊断曲线下面积（AUC）为0.954，最佳截断值为97%，灵敏度为100%，特异性为83.3%。isth显性DIC的优势比为2.894，表明LI60升高与DIC的发生有很强的相关性。低纤溶预测28天死亡率和高SOFA评分（≥10），具有高特异性和阴性预测值（NPV）。Kaplan-Meier曲线显示，Hypo组的临床结果明显差于Normal组和Hyper组。结论：对于脓毒症患者，纤溶抑制表现为“低纤溶”（LI60升高）与预后差和更高器官功能障碍风险相关。此外，它是脓毒症不良临床结果的重要预测因子。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Thrombosis research 医学-外周血管病

CiteScore

14.60

自引率

4.00%

发文量

364

审稿时长

31 days

期刊介绍： Thrombosis Research is an international journal dedicated to the swift dissemination of new information on thrombosis, hemostasis, and vascular biology, aimed at advancing both science and clinical care. The journal publishes peer-reviewed original research, reviews, editorials, opinions, and critiques, covering both basic and clinical studies. Priority is given to research that promises novel approaches in the diagnosis, therapy, prognosis, and prevention of thrombotic and hemorrhagic diseases.