Comparison of point-of-care hemostatic assays, routine coagulation tests, and outcome scores in critically ill patients

• Published in: Journal of critical care Vol. 30; no. 5; pp. 1032 - 1038
• Main Authors: Larsson, A., MD, Tynngård, N., PhD, Kander, T., MD, PhD, Bonnevier, J., MF, PhD, Schött, U., MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2015; Elsevier Limited
• Subjects: Aged; Aggregation; Anestesi och intensivvård; Anesthesiology and Intensive Care; Blood; Blood Coagulation - physiology; Blood Coagulation Disorders - blood; Blood Coagulation Tests - methods; Blood platelets; Blood Platelets - physiology; Clinical Medicine; Coagulopathy; Critical Care; Critical Illness; Electrodes; Female; Fibrinogen; Hemostasis - physiology; Hospitals; Humans; Intensive care; Intensive Care Units; Klinisk medicin; Male; Medical and Health Sciences; Medicin och hälsovetenskap; Methods; Mortality; Organ Dysfunction Scores; Partial Thromboplastin Time; Platelet Count - methods; Platelets; Point-of-Care Systems; Prognosis; Prospective Studies; Sepsis; Survival; Thrombelastography - methods; Thromboelastography; Viscoelasticity; Aggregation; Thromboelastography; Platelets; Survival; Coagulopathy
• ISSN: 0883-9441; 1557-8615; 1557-8615
• DOI: 10.1016/j.jcrc.2015.06.014

Abstract Purpose The purposes of the study are to compare point-of-care (POC) hemostatic devices in critically ill patients with routine laboratory tests and intensive care unit (ICU) outcome scoring assessments and to describe the time course of these variables in relation to mortality rate. Materials and methods Patients admitted to the ICU with a prognosis of more than 3 days of stay were included. The POC devices, Multiplate platelet aggregometry, rotational thromboelastometry, and ReoRox viscoelastic tests, were used. All variables were compared between survivors and nonsurvivors. Point-of-care results were compared to prothrombin time, activated partial thromboplastin time, platelet count, fibrinogen concentration, and Sequential Organ Failure Assessment score and Simplified Acute Physiology Score 3. Results Blood was sampled on days 0 to 1, 2 to 3, and 4 to 10 from 114 patients with mixed diagnoses during 237 sampling events. Nonsurvivors showed POC and laboratory signs of hypocoagulation and decreased fibrinolysis over time compared to survivors. ReoRox detected differences between survivors and nonsurvivors better than ROTEM and Multiplate. Conclusions All POC and routine laboratory tests showed a hypocoagulative response in nonsurvivors compared to survivors. ReoRox was better than ROTEM and Multiplate at detecting differences between surviving and nonsurviving ICU patients. However, Simplified Acute Physiology Score 3 showed the best association to mortality outcome.