Thromboelastography vs Conventional Coagulation Assays in Sepsis Induced Coagulopathy at IC Admission – A Prospective Observational Study

INTRODUCTION: Sepsis is a life-threatening condition that Involves complex circulatory disturbances of which coagulopathy is a common occurrence and can manifest as both bleeding and thrombotic complications. Septic patients utilize traditional coagulation tests such as platelet count, activated partial thromboplastin time and international normalized ratio to assess their coagulation status. These tests have limitations in accurately reflecting the dynamic coagulation process.(1) Thromboelastography is a flexible point-of-care coagulation test that has benefits over conventional test like quicker results and efficacy. This study aimed to use TEG to compare the coagulation patterns in septic patients with abnormal coagulation profiles. OBJECTIVES: PRIMARY: To determine proportion of patients with sepsis-induced coagulopathy measured using conventional coagulation assays who have true hypocoagulopathy using TEG. SECONDARY: To evaluate coagulation pattern of sepsis patients with sepsis-induced coagulopathy detected using conventional coagulation assays of coagulation parameters using TEG coagulation index. To compare coagulation patterns in sepsis without and with shock using TEG coagulation index. To determine the 28 days mortality of patients using initial TEG Coagulation index. MATERIALS AND METHODS: SETTING: Department of Critical Care. DESIGN: Prospective observational study. POPULATION: 62 Patients admitted to the Medical Intensive Care Unit with sepsis and coagulopathy, detected through conventional coagulation assays, with no clinical bleeding. INCLUSION CRITERIA: Patients admitted with sepsis-induced coagulopathy and no bleeding manifestations. Age > 18 years. Patients with abnormalities in any of conventional coagulation assays. EXCLUSION CRITERIA: Patients with bleeding dyscrasias or other conditions causing bleeding dyscrasias, chronic liver disease, immune thrombocytopenic purpura, thrombotic thrombocytopenic purpura., hematological malignancies. Patients on anticoagulants. RESULTS: Comparing conventional coagulation assays of the sepsis induced coagulopathy patients with TEG, 62.9% exhibited hypocoagulability, as indicated by a coagulation index (CI) below −3, while the remaining 37.1% were normo-coagulable (CI between −3 and +3). A crosstabulation analysis showed that 82.1% of hypo-coagulable patients were in septic shock compared to 30.4% of normocoagulable patients (p < 0.001) indicating that hypo-coagulability was significantly associated with septic shock. This study also showed Hypo coagulability was strongly associated with a higher 28-day mortality rate (69.2% vs. 17.4%, p < 0.001). DISCUSSION: Our study demonstrated that, according to conventional coagulation indices, all patients (100%) were initially classified as hypocoagulable. However, thromboelastography revealed a more detailed picture only 62.9% of patients remaining hypocoagulable, while 37.1% were found to be normocoagulable. These findings are consistent with other studies that have used TEG to assess coagulation profiles in septic patients, for instance, Muzaffar et al., (2017)(2) reported that their septic shock patients exhibited a distribution of normocoagulable (56%), hypercoagulable (27%), and hypocoagulable (17%) profiles. This highlights the discrepancy between conventional coagulation tests and TEG in detecting coagulopathy.