Comparisons of coagulation characteristics between elderly and non-elderly patients with sepsis: A prospective study

医学 血栓弹性成像 重症监护室 凝血酶原时间 纤维蛋白原 部分凝血活酶时间 败血症 混凝试验 前瞻性队列研究 凝结 内科学 弥漫性血管内凝血 胃肠病学 外科
作者
Chengrui Zhu,Zhenzhen Hou,Ran Zhu,Baosen Zhou,Yini Sun,Zhiliang Li,Xu Li,Renyu Ding,Zhenggang Luan,Yingjian Liang,Liang Wang,Xiaochun Ma
出处
期刊:Surgery [Elsevier BV]
卷期号:173 (5): 1303-1310 被引量:4
标识
DOI:10.1016/j.surg.2023.01.002
摘要

Background A blunt host defense response in older patients may contribute to different coagulation responses during sepsis. We aimed to investigate the differences in coagulation parameters between elderly and non-elderly patients with sepsis. Methods Adult patients diagnosed with sepsis within 24 hours after admission to the intensive care unit between September 2018 and December 2020 were prospectively enrolled. Patients were categorized into the adult (18–64 years) and elderly (age ≥65 years) groups. Conventional coagulation parameters and inflammatory markers were measured on intensive care unit admission and on Days 3 and 7. Thromboelastography was performed on intensive care unit admission. The differences in the coagulation parameters between the 2 groups were evaluated. The adult and elderly patients were matched to adjust for baseline characteristics. Correlations between inflammatory markers and coagulation-related parameters were also analyzed. Results Of the 567 patients, 303 (53.4%) were elderly. Compared with adult patients, elderly patients had lower prothrombin time elevation, lower fibrinogen, D-dimer, and fibrin/Fib degradation product levels, and lower proportion of disseminated intravascular coagulation on intensive care unit admission; and, they had lower dynamic platelet, lower fibrinogen, and D-dimer levels during the first week in the intensive care unit. Thromboelastography parameters were generally within the normal range, although elderly patients had lower R and K values and a higher alpha angle. Comparisons of coagulation parameters between the 2 groups revealed similar results in the matched cohort. The inflammatory markers correlated with prothrombin time, activated partial thromboplastin time, and antithrombin III. Conclusion Elderly patients had milder coagulation activation, accompanied by a decreased inflammatory response during sepsis, compared to non-elderly patients.
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