To explore the role of thromboelastography (TEG) parameters in the diagnosis and prognosis evaluation of disseminated intravascular coagulation (DIC) in patients with sepsis.

From January 1, 2021 to December 31, 2021, 100 patients with sepsis meeting Sepsis 3.0 criteria, who underwent thromboelastography on the day of admission and were screened for sepsis by the DIC early warning system, were collected at the Department of Critical Care Medicine, Shanghai Pudong New Area People's Hospital. The general and clinical data of the patients, including age, gender, peripheral blood parameters on the day of admission (initial blood lactate, white blood cell count, platelet count, C-reactive protein, hemoglobin, albumin, D-dimer, fibrinogen concentration, prothrombin time, international normalized ratio, and partial thromboplastin time), and thromboelastography parameters [reaction time, clot formation time and rate of formation (alpha angle), and maximum amplitude (MA)], as well as SOFA score, APACHE II score, and 90-day survival status were recorded. According to the presence of DIC or not, the patients were divided into either a DIC group or a non-DIC group. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of thromboelastometry for DIC in patients with sepsis, and the Kaplan-Meier curve was used to explore its impact on the prognosis of patients with sepsis.

Comparing the coagulation indexes of the two groups, it was found that PT (P=0.011) and INR (P＜0.001) were prolonged in the DIC group. Regarding the thromboelastography parameters, reaction time (P＜0.001) and clot formation time (P＜0.001) were significantly prolonged in the DIC group, while α angle (P=0.001) and MA (P＜0.001) were significantly decreased. ROC curve analysis showed that the areas under the curves of reaction time and clot formation time for the diagnosis of DIC were 0.928 (95% confidence interval [CI]: 0.875~0.982) and 0.752 (95%CI: 0.638~0.866), respectively, while those of the alpha angle and MA for excluding DIC were 0.720 (95%CI: 0.602~0.837) and 0.930 (95%CI: 0.878~0.979), respectively. ROC analysis of thromboelastography parameters for predicting 90-day survival in patients with sepsis revealed that the area under the curve for MA was 0.707 (95%CI: 0.578~0.836), while reaction time, clot formation time, and alpha angle were not predictive. Kaplan-Meier survival curve analysis also demonstrated that MA value was a good predictor of 90-day survival in patients with sepsis (P=0.001).

TEG parameters can be used as an effective method to diagnose and exclude DIC. MA value can be used as a good indicator to predict the 90-day survival rate of sepsis patients.