Clinical Value Of Thromboelastography In The Diagnosis And Treatment Of Children With Sepsis

ObjectiveSepsis is a critical illness associated with common infections in pediatrics,with a high mortality,and the interaction between uncontrolled inflammation and coagulation disorders is considered to be the most fundamental pathological changes of sepsis.Therefore,looking for a more sensitive and rapid method to evaluate the coagulation disorder of sepsis is helpful to identify the serious patients earlier.The purpose of this study was to explore the clinical value of thromboelastography in the diagnosis and treatment of sepsis in children.MethodA retrospective study was conducted on 66 children with sepsis diagnosed within24 hours of Children’s Hospital of Zhejiang University from July 2017 to November2019,which were divided into sepsis group and septic shock group,and 50 children who underwent cardiac catheterization in the same period served as the control group.SPSS 20.0 statistical software was used to assess the date,compare the Classical coagulation laboratory tests and TEG indexes between groups,analyze the correlation between coagulation index and platelet,p SOFA score,and evaluate their prognostic value.Result1.The results of general clinical data analysis:Comparing the three groups of sepsis, septic shock,and control groups,it can be seen that as the infection worsens,the mortality and p SOFA scores increase,while platelets show a downward trend.There was no significant difference in gender and age(P>0.05).2.Analysis of classical coagulation laboratory tests results:After pairwise comparison of the mean values of each group,it was found that there was significant difference in APTT,PT,TT and INR between sepsis group and septic shock group(P<0.05),but there was no significant difference between sepsis group and control group (P>0.05).APTT,PT,TT were longer and INR was higher in the septic shock group than in the sepsis group.3.Analysis of TEG indexes results:pairwise comparison found that TEG indexes xcept K value in septic shock group were significantly different from those in eptic shock group and control group(P<0.05),but all indexes between sepsis group nd control group found no.significant difference.The TEG indexes of the septic shock group indicated hypocoagulable state.4.Correlation analysis between platelet count and coagulation index: there was a ignificant correlation between platelet count and all parameters in TEG ndex(P<0.01),and the correlation coefficient was higher than that of classical oagulation laboratory tests.The correlation coefficients with R value,K value,Angle,MA and CI were-0.48,-0.65,0.63,0.69,0.77 respectively.5.Correlation analysis between p SOFA score and coagulation index: p SOFA score as correlated with other coagulation indexes except Fib(P<0.05).It positively orrelated with R value(0.56),INR(0.48),PT(0.53),TT(0.30),INR(0.51),D-dimer(0.42),and negatively correlated with K value(-0.35),Angle(-0.68),MA -0.68)and CI(-0.37).6.Evaluation of prognosis by classical coagulation laboratory tests and TEG ndexes:The Area Under Curve of APTT,PT,INR and D-dimer in classical oagulation laboratory tests were all more than 0.7,which were 0.892,0.752 and .762 respectively,while the indexes of TEG had no correlation with prognosis.ConclusionsCoagulation index can evaluate the severity of sepsis.Compared with classical coagulation laboratory tests,TEG index can identify hypocoagulable state in children with septic shock,evaluate the function of platelet and Fib,and has a higher correlation with SOFA score,which can help to further guide diagnosis and treatment,while classical coagulation laboratory tests can more accurately assess prognosis.