Hemoglobin Concentration Impacts Viscoelastic Hemostatic Assays in ICU Admitted Patients.
Hemoglobin Concentration Impacts Viscoelastic Hemostatic Assays in ICU Admitted Patients.
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血红蛋白浓度影响 ICU 入院患者的粘弹性止血测定。
DOI：
10.1097/ccm.0000000000005700
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发表时间：
2023
影响因子：
8.8
通讯作者：
中科院分区：
文献类型：
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作者：
Roh,DavidJ;Chang,TiffanyR;Kumar,Aditya;Burke,Devin;Torres,Glenda;Xu,Katherine;Yang,Winni;Cottarelli,Azzurra;Moore,Ernest;Sauaia,Angela;Hansen,Kirk;Velazquez,Angela;Boehme,Amelia;Vrosgou,Athina;Ghoshal,Shivani;Park,Soojin;
目的：低血红蛋白浓度影响多种疾病的临床止血。目前尚不清楚血红蛋白是否影响实验室功能凝血评估。我们评估了脑出血（ICH）患者的粘弹性止血试验中血红蛋白浓度与ICU围手术期患者的关系。设计：观察性队列研究和单独的体外实验室研究。环境：多中心三级转诊icu。患者：两个急性脑出血队列接受不同的检测方式：旋转血栓弹性测量（ROTEM）和血栓弹性成像（TEG），第三个外科ICU队列接受ROTEM进行评估，以评估在疾病过程和测试平台上发现的普遍性。利用脑出血患者的血液样本进行了单独的体外ROTEM实验室研究。干预：无。测量和主要结果：基线血红蛋白和ROTEM/TEG结果之间的关系分别在患者队列中使用Spearman相关和线性回归模型进行评估。另一项单独的体外研究评估了脑出血患者血液样本中一系列血红蛋白修饰后的ROTEM追踪变化。在我们的ROTEM （n= 34）和TEG (n= 239) ICH队列中，血红蛋白浓度与凝血动力学直接相关（ROTEM r: 0.46, p= 0.01; TEG r: 0.49, p< 0.0001），与凝块强度负相关（ROTEM r: -0.52, p= 0.002; TEG r: -0.40, p< 0.0001）。在围手术期ICU住院患者中也发现了类似的关系（n= 121）。我们继续在线性回归模型中确定这些关系。当在体外操作脑出血患者血液样本以达到较低的血红蛋白浓度时，我们同样发现较低的血红蛋白浓度导致ROTEM示踪上逐渐加快的凝血动力学和更大的凝块强度。结论：较低的血红蛋白浓度对ICU住院患者的ROTEM/TEG检测有一致的、可测量的影响，这似乎是人为的。低血红蛋白患者可能表面上有正常的粘弹性参数，但实际上，他们有轻度低凝状态。需要进一步的工作来确定这些测试是否应该根据患者的血红蛋白浓度进行校正。
OBJECTIVES:Low hemoglobin concentration impairs clinical hemostasis across several diseases. It is unclear whether hemoglobin impacts laboratory functional coagulation assessments. We evaluated the relationship of hemoglobin concentration on viscoelastic hemostatic assays in intracerebral hemorrhage (ICH) and perioperative patients admitted to an ICU.DESIGN:Observational cohort study and separate in vitro laboratory study.SETTING:Multicenter tertiary referral ICUs.PATIENTS:Two acute ICH cohorts receiving distinct testing modalities: rotational thromboelastometry (ROTEM) and thromboelastography (TEG), and a third surgical ICU cohort receiving ROTEM were evaluated to assess the generalizability of findings across disease processes and testing platforms. A separate in vitro ROTEM laboratory study was performed utilizing ICH patient blood samples.INTERVENTIONS:None.MEASUREMENTS AND MAIN RESULTS:Relationships between baseline hemoglobin and ROTEM/TEG results were separately assessed across patient cohorts using Spearman correlations and linear regression models. A separate in vitro study assessed ROTEM tracing changes after serial hemoglobin modifications from ICH patient blood samples. In both our ROTEM (n= 34) and TEG (n= 239) ICH cohorts, hemoglobin concentrations directly correlated with coagulation kinetics (ROTEM r: 0.46; p= 0.01; TEG r: 0.49; p< 0.0001) and inversely correlated with clot strength (ROTEM r:–0.52, p= 0.002; TEG r:–0.40, p< 0.0001). Similar relationships were identified in perioperative ICU admitted patients (n= 121). We continued to identify these relationships in linear regression models. When manipulating ICH patient blood samples to achieve lower hemoglobin concentrations in vitro, we similarly identified that lower hemoglobin concentrations resulted in progressively faster coagulation kinetics and greater clot strength on ROTEM tracings.CONCLUSIONS:Lower hemoglobin concentrations have a consistent, measurable impact on ROTEM/TEG testing in ICU admitted patients, which appear to be artifactual. It is possible that patients with low hemoglobin may appear to have normal viscoelastic parameters when, in fact, they have a mild hypocoagulable state. Further work is required to determine if these tests should be corrected for a patient’s hemoglobin concentration.