Rotational Thromboelastometry-Assessed Clotting Times as Predictors of Mortality in Shock-Induced Endotheliopathy (SHINE) Among Critically Ill Patients

Background: Coagulopathies are common in patients with septic shock, trauma, or post-cardiac arrest syndrome, resulting from endothelial injury due to hypoperfusion in shock-induced endotheliopathy (SHINE). However, the prognostic efficacy of SHINE-associated coagulopathies has not been studied widely and there is no assessment of prognostic value for coagulation parameters measured by rotational thromboelastometry (ROTEM®) in this group of patients. Methods: We retrospectively analyzed data from consecutive adult patients with SHINE who underwent ROTEM® testing within 72 hours of admission to our mixed medical-surgical ICU from January 2020 to December 2023. We evaluated the association between clotting times (CTs) in the extrinsic (EXTEM) and intrinsic (INTEM) coagulation pathways and 30-day mortality. Results: There were 114 patients included (mean age of 49.3 years, 66.7% males), with 30-day mortality rate of 45.6%. CT EXTEM and CT INTEM were significantly prolonged in non-survivors compared to survivors (median [IQR]; 95.5 [72.0-176.3] vs. 74.5 [65.8-83.5] seconds, p < 0.001 and median [IQR]; 268.0 [229.0-361.5] vs. 201.0 [175.8-251.0] seconds, p <0.001, respectively). In multivariable logistic regression, both CT EXTEM and CT INTEM were independently associated with a higher risk of mortality, even after adjusting for age and APACHE II scores (OR = 1.024; 95% CI = 1.011-1.038; p < 0.001 for EXTEM; OR 1.006; 95% CI = 1.001-1.010; p = 0.009 for INTEM) and in ROC analysis demonstrated predictive value for 30-day mortality, with AUC values of 0.727, p < 0.001 and 0.741, p < 0.001, respectively. Conclusions: Prolonged CTs in EXTEM and INTEM are independent predictors of 30-day mortality in critically ill patients with SHINE-associated coagulopathies. ROTEM® parameters should be considered as early predictors of mortality in this group of patients.