Impact of uremia on platelet contribution to clot strength assessed with rotational thromboelastometry: A retrospective cohort study in septic patients.

INTRODUCTION

Sepsis remains a leading cause of morbidity and mortality among critically ill patients and is frequently complicated by coagulopathy and thrombocytopenia. The study aimed to evaluate the impact of uremia on platelet contribution to clot strength in septic patients using rotational thromboelastometry (ROTEM) and determine whether platelet contribution to clot strength is associated with short-term mortality.

MATERIAL AND

METHODS

This retrospective cohort study was carried out in an intensive care unit (ICU). Clinical, biochemical, hematological, and coagulation parameters were retrieved. Patients receiving antiplatelet agents or oral anticoagulants were excluded.

RESULTS

There were 107 adult patients diagnosed with sepsis or septic shock in whom ROTEM was performed upon ICU admission. ROTEM-derived platelet contribution in patients without sepsis-induced coagulopathy (SIC) showed a significant inverse correlation with blood urea nitrogen and urea concentrations, but not with creatinine, estimated glomerular filtration rate, or creatinine clearance. ICU mortality in the cohort was 34.6%, exceeding the predicted mortality rate. Platelet contribution was independently associated with ICU mortality after adjustment for age, sex, presence of SIC, and SOFA score.

CONCLUSIONS

Uremia is associated with impaired platelet contribution to clot strength in patients without SIC. This impairment independently predicts ICU mortality. These findings underscore the importance of a multifaceted approach to renal assessment and support the integration of viscoelastic testing into the diagnostic and prognostic framework for sepsis.