ROTEM in critically ill patients at risk for DIC

Disseminated intravascular coagulation (DIC) is a devestating complication of critical illness and an independent predictor of organ failure and mortality. DIC is characterized by systemic vascular activation with ensuing consumption coagulopathy with microthrombi formation. Thereby, patients are at risk for both bleeding and thromboembolic events. However, specific risk factors for bleeding and thrombosis are unknown. Current diagnostics rely on conventional coagulation testing to calculate a DIC score. However, this score cannot predict the risk for thrombosis or bleeding and hence cannot discriminate which patients would benefit from an anticoagulant strategy. Rotational thromboelastometry (ROTEM) may have the potential to diagnose both DIC as well as predict risks of bleeding and thrombosis in patients at risk for DIC.

The aim of our study is twofold: 1) to measure ROTEM profiles in critically ill patients at risk for DIC to determine cut off values of ROTEM corresponding to the currently used International Society for Thrombosis and Haemostasis (ISTH) DIC scores, as well as to bleeding and thromboembolic events. 2) to measure damage associated molecular patterns (DAMPs) and other parameters of the DIC coagulation cascade to improve insight in the pathophysiology of DIC.

ROTEM is able to detect DIC and predict which patients are at risk of bleeding or thrombosis. Furthermore, we hypothesize thromboembolic events due to DIC occur when fibrinogen drops below a certain value compared to DAMP levels.

Single blood draw between day 1 - 4 of ICU stay.