• Fibi Ninan K, Ramya Iyadurai, Justin K Varghese, Tulasi Geevar, Sukesh C Nair, Bijesh Yadav, Ronald Albert Benton Carey, Mohammad Sadiq J, Maria Koshy, Ravikar Ralph, and John Victor Peter.
• Department of Medicine, Christian Medical College (CMC), Vellore, India. Electronic address: fibininank@gmail.com.
• J Crit Care. 2021 Oct 1; 65: 177-183.

BackgroundCoagulation abnormalities are not infrequent in sepsis. It is unclear if abnormalities in thromboelastogram (TEG) are associated with mortality in patients with severe sepsis without overt bleeding.Materials And MethodsIn this prospective study, patients were categorised as those with normal coagulation, hypercoagulable or hypercoagulable state based on admission TEG parameters (R time, K time, Maximum amplitude (MA), α angle). Their association with mortality was explored using Fisher's exact and Mann-Whitney U test as appropriate.ResultsThe study cohort (n = 87; 49 male) with median (IQR) age 51 (42-60) years and admission SOFA score 8 (6-11) included scrub typhus (24.1%), pneumonia (22.6%) and urosepsis (10.3%). Non-invasive and invasive ventilation and vasopressors were required in 28.1%, 68.9% and 74%, respectively. Mortality was 24.1%. Based on R time, K time and α angle, 3.5% to 9.3% had a hypercoagulable state and 26.7 to 29.9% were hypocoagulable. Prolonged R time (p = 0.04) and reduced alpha angle (p = 0.01) in patients with hypocoagulable state was associated with mortality. K time, α angle and MA were significantly different in patients requiring transfusion (p < 0.001).ConclusionA subset of patients with severe sepsis without overt bleeding are hypocoagulable. Hypocoagulability is associated with mortality and need for transfusion.Copyright © 2021 Elsevier Inc. All rights reserved.

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