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CC BY 4.0 · TH Open 2024; 08(01): e164-e174
DOI: 10.1055/a-2270-7673
Original Article

Impaired Whole-Blood Fibrinolysis is a Predictor of Mortality in Intensive Care Patients

Julie S. Brewer
1   Department of Clinical Biochemistry, Thrombosis and Hemostasis Research Unit, Aarhus University Hospital, Aarhus, Denmark
,
Christine L. Hvas
2   Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
3   Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
,
Anne-Mette Hvas
4   Dean of the Faculty of Health, Aarhus University, Aarhus, Denmark
,
Julie B. Larsen
1   Department of Clinical Biochemistry, Thrombosis and Hemostasis Research Unit, Aarhus University Hospital, Aarhus, Denmark
3   Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
› Author Affiliations Funding This work was supported by the Independent Research Fund Denmark (grant number 2061-00030B) and Karen Elise Jensen's Foundation.
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Abstract

Background Altered fibrinolysis is considered to play a crucial role in the development of coagulopathy in sepsis. However, routine laboratory tests for fibrinolysis are currently very limited, and the impact of fibrinolytic capacity on clinical outcome is poorly investigated.

Objectives To assess whole-blood fibrinolysis in patients admitted to the intensive care unit (ICU) and compare fibrinolysis in sepsis patients with nonsepsis patients. Further, to investigate associations between fibrinolytic capacity and 30-day mortality and venous thromboembolism (VTE).

Methods This study was designed as a prospective cohort study. Adult ICU patients were included at the Aarhus University Hospital, Denmark. All patients had a blood sample obtained the morning after admission. A modified thromboelastometry (ROTEM®) analysis with tissue plasminogen activator (ROTEM®-tPA) was used to assess fibrinolysis. The primary endpoint was difference in ROTEM®-tPA lysis time between sepsis patients and nonsepsis patients.

Results ROTEM®-tPA revealed fibrinolytic impairment in sepsis patients (n = 30) compared with nonsepsis ICU controls (n = 129), with longer lysis time (median [interquartile range] 3,600 [3,352–3,600] vs. 3,374 seconds [2,175–3,600], p < 0.01), lower maximum lysis (23 [8–90] vs. 94% [14–100], p = 0.02), and lower fibrinolysis speed (0.41 [0.0–1.4] vs. 1.6 mm/min [0.1–2.7], p = 0.01). In the composite ICU population, 61% (97/159) demonstrated prolonged lysis time indicating impaired fibrinolytic capacity. These patients had higher 30-day mortality (adjusted odds ratio [OR]: 2.26 [0.83–6.69]) and VTE risk (OR: 3.84 [0.87–17.8]) than patients with normal lysis time.

Conclusion Sepsis patients showed impaired fibrinolysis measured with ROTEM®-tPA compared with nonsepsis patients and ROTEM®-tPA lysis time was associated with 30-day mortality and VTE in the entire ICU cohort.

Keywords

blood coagulation tests - critical care - fibrinolysis - sepsis - thromboelastography

Author Contributions

J. B.L., C.L.H., and A.M.H. designed the current study. J.S.B. performed patient inclusion, ROTEM®-tPA analysis, clinical data collection and data analysis, and wrote the initial draft of the manuscript. All authors interpreted the results, critically revised this manuscript, and approved the final version.




Publication History

Received: 27 November 2023

Accepted: 12 February 2024

Accepted Manuscript online:
16 February 2024

Article published online:
28 March 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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