Categorizing Sepsis-induced Coagulopathy Using Thromboelastography: An Approach to Address the Second Pillar of Patient Blood Management

Background and aims: A severity-matched case-control study was done to analyze the efficacy of thromboelastography (TEG) in diagnosing and categorizing sepsis-induced coagulopathy (SIC) by addressing the second pillar of patient blood management, i.e. minimizing bleeding and blood loss. Patients and methods: Sepsis-induced coagulopathy managed with TEG data was collected from 2020 to 2021, and severity-matched retrospective data where SIC managed with conventional tests was collected from 2018 to 2019, which comprised the control group. Age > 18 years, SIC requiring critical care admission were the inclusion criteria. The Sequential Organ Failure Assessment (SOFA) scoring system was used for severity matching. Coagulopathy was defined as an abnormal coagulation screen or TEG parameters. Results: A total of 125 patients were included in the TEG-based management, and 118 in the control group. Out of 125, TEG-based diagnosis showed normal, hypo, and hypercoagulable status in 26, 66, and 33 patients, respectively. Hypocoagulable picture was more predominant with an increase in the SOFA score. Severity-matched control group analysis showed that individualized hemostasis management with TEG resulted in a 58% reduction in mortality rate (from 91.67% to 38.4%, p ≤ 0.0001). A hypocoagulable TEG had a higher risk of mortality (OR = 1.89, CI = 0.909–3.963). Kaplan-Meier survival analysis showed that individualized management of SIC had a favorable outcome using TEG-based data (Log rank 12.4, p < 0.001). Conclusion: Patient blood management in SIC with TEG differentiates hypercoagulable from hypocoagulable patients, thus providing clarity in clinical decision-making to improve patient survival.