Prognostic Evaluation Of Thromboelastography Combined With Arterial Blood Lactate In Patients With Sepsis-induced Coagulopathy

Objective:To investigate the value of combined thromboelastography(TEG)and arterial blood lactate(Lac)testing in assessing survival outcomes in patients with sepsis-induced coagulopathy(SIC).Methods:Eighty-one patients with sepsis-induced coagulation dysfunction admitted to the emergency department of Bethune Hospital in Shanxi,China,from June 2021 to October2022 were collected and divided into 56 patients in the survival group and 25 patients in the death group based on 90-day regression.The clinical data,biochemical parameters such as TEG parameters R value,K value,α angle,MA value,CI value and Lac were compared between the two groups;subject work characteristic(ROC)curves were drawn to compare the prognostic value of each TEG parameter on SIC patients;logistic regression analysis of independent influencing factors of survival outcome was performed to determine the correlation between TEG,Lac and 90-day death of SIC patients,and the independent influencing factors as the basis for constructing the joint prediction model;plotting the subject work characteristic(ROC)curves,comparing the AUC quality using Delong test to assess the predictive value of TEG parameters,Lac and the joint prediction model on the prognosis of SIC patients.Results:1.Univariate influencing factors in SIC patients: Lac,PCT,SOFA score,APACHE II score,TEG R value,and K value were higher in the death group than in the survival group;MAP,α angle,MA value,and CI value were lower than in the survival group,and the difference between the two groups was statistically significant(P < 0.05).2.logistic regression analysis of independent influences affecting survival outcome in SIC patients: TEG CI value(OR=0.63,95% CI0.4-0.99,P=0.05)versus Lac(OR=3.32,95% CI1.23-8.93,P=0.02).3.The ROC curve analyzed the predictive ability of TEG CI value,Lac and the combination of both for 90-day survival outcome of SIC patients: the AUC of TEG CI value was 0.79,the best cut-off value was 0.67,the sensitivity was 64.3%,and the specificity was 88%;the AUC of Lac was 0.72,the best cut-off value was 2.65 mmol/L,the sensitivity was 92.9%,and the specificity was The AUC of the combined prediction model was 0.83,the best cut-off value was 0.22,the sensitivity was 100%,and the specificity was 58%.The AUC quality of the two combined was better than Lac(P=0.03),and there was no significant difference in comparison with the TEG CI value.Conclusion:1.Prolonged TEG K values and decreased alpha angle,MA values and CI values indicate a hypocoagulable state of coagulation,suggesting a poor 90-day prognosis for SIC patients.2.TEG CI value and Lac are independent factors influencing 90-day death in patients with SIC,with CI value as a protective factor and Lac as a risk factor.3.TEG CI value and Lac value can be used as indicators to evaluate the prognosis of SIC patients,and the combined detection value of the two indicators is better than that of a single indicator for the survival outcome of SIC patients.