75; CI 0.666 – 0.846; P < 0.001). The ROC curves for these variables are shown in Figure Figure1.1. selleck chem Comparison of the lysis index in probands and patients with sepsis, respectively, demonstrated that the variable was capable of detecting differences between these groups with high accuracy, too (AUC 0.890; CI 0.845 – 0.977; P < 0.001).Figure 1Receiver operating characteristic curves comparing thromboelastometry lysis index and procalcitonin concentration for the diagnosis of severe sepsis in critically ill patients.Optimal cut-off values for lysis index and procalcitonin concentration for the diagnosis of sepsis in critically ill adultsOptimal cut-off values were determined as described in the Methods section. For the lysis index, the optimum cut-off was > 96.5%, resulting in a sensitivity of 84.
2% and a specificity of 94.2%. Applying this cut-off for the comparison of probands and sepsis patients, respectively, resulted in a sensitivity of 83.9% and a specificity of > 99%. The optimum cut-off for procalcitonin concentration was > 2.58 ng/ml, resulting in a sensitivity of 70.2% and a specificity of 75.0%.Odds ratios for the biomarkers for the diagnosis of sepsis in critically ill patientsWhen applying these calculated optimum cut-off values for the biomarkers, the resulting odds ratios for the detection of severe sepsis in critically ill patients were 85.3 (CI 21.7 – 334.5; P < 0.001) for the lysis index and 6.3 (CI 2.7 - 14.4; P < 0.001) for procalcitonin concentration.DiscussionOur results demonstrate that the thromboelastometry lysis index can discriminate intensive care patients with severe sepsis from postoperative patients and probands.
Furthermore, comparison of thromboelastometry findings with the conventional biomarkers procalcitonin, interleukin 6, and C-reactive protein demonstrates a superior accuracy of the thromboelastometry lysis index in identifying patients with severe sepsis in critically ill patients. Finally, the data indicate that the fibrinolytic system is inhibited in nearly all patients with severe sepsis.Thromboelastometry is a point-of-care method capable of determining the kinetics of clot formation and clot lysis in whole-blood samples, thereby assessing the viscoelastic properties of the clot [12].
The clotting variables obtained by thromboelastometry include the clotting time, representing the time to onset of coagulation, the clot-formation time and alpha angle, both of which describe the kinetics of clot formation, and the maximum clot firmness, describing the mechanical properties of the clot, which depends on both platelet count and fibrin polymerization. For Carfilzomib the determination of the lysis index, the clot firmness prevailing 60 minutes after maximum clot firmness is reached, is divided by the maximum clot firmness. Thromboelastometry is widely accepted in cardiac and liver transplantation surgery [13,14], but studies on its use in sepsis are sparse.
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