PB1128 - Serial thromboelastography as bleeding and mortality predictors in severe COVID-19 patients

Tuesday, June 25, 2024

13:45 – 14:45 ICT

Room: Exhibition Hall

Presenting Author(s)

US

Usi Sukorini, MD, DR

Associate Professor
Universitas Gadjah Mada
Yogyakarta, Yogyakarta, Indonesia

Co-Author(s)

AA

Agusta Adipradipta

Specialist Student
Unoversitas Gadjah Mada
Yogyakarta, Yogyakarta, Indonesia
SA

Sagita Adventia

Specialist student
Universitas Gadjah Mada
Yogyakarta, Yogyakarta, Indonesia
AI

Annisa Indrarsi

Specialist student
Universitas Gadjah Mada
Yogyakarta, Yogyakarta, Indonesia
IR

Ika Ridlawati

Specialist student
Universitas Gadjah Mada
Yogyakarta, Yogyakarta, Indonesia
AA

Adika Arjana

PhD student
Universitas Gadjah Mada
Yogyakarta, Yogyakarta, Indonesia
AP

Angeline Purnamasari

Specialist student
Universitas Gadjah Mada
Yogyakarta, Yogyakarta, Indonesia

Background: Hypercoagulable state is a complication of COVID-19 may increase risks of thrombosis, disseminated intravascular coagulation (DIC) and bleeding. Serial monitoring of bleeding in Intensive Care Unit (ICU) setting is necessary to prevent mortality. Serial thromboelastography (TEG) to assess in vitro blood coagulability, might be able to predict bleeding and mortality

Aims: To determine the best time for serial TEG examination to predict bleeding and death in severe COVID-19 patients in ICU

Methods: A longitudinal observational analytical design was carried out in the study. The subjects were severe COVID-19, 24 hours after admission to ICU at Dr. Sardjito Hospital, Yogyakarta. Patients with acute limb ischemia (ALI), deep vein thrombosis (DVT), and haematological malignancies were excluded. TEG examinations were performed on day 1, 3, 5 and 10 after admission to ICU. Bleeding and death were recorded as outcomes. We analyzed area under curve (AUC) from receiver operating characteristic (ROC) curves and OR of delta TEG on each day of measurement at the risk of bleeding and mortality, and p-value of < 0.05 was considered statistically significant

Results: From 44 patients, 20(34.5%) patients died and 23(52.3%) patients had bleeding events. The delta of days 1-3 have significant R, K, Angle, and MA parameters in predicting bleeding and death. The utility of the MA delta in predicting mortality was described by AUC of 0.792, with a delta cut-off of 5.1 and an odds ratio of 9.7 (p=0.001), while the utility of the R delta to predict bleeding was described by AUC of 0.749, with a delta cut-off of 1.95 and an odds ratio of 9.1 (p=0.002).

Conclusion(s): Delta values of R, MA and angle TEG between day 1-3 after admission to ICU were important predictors of bleeding and mortality in severe COVID-19