Platelet dysfunction in heatstroke-induced coagulopathy: A retrospective observational study

Yuri Endo; Ryota Inokuchi; Miyuki Yamamoto; Ryohei Horie; Toshifumi Asada; Koichi Kashiwa; Kazuki Fujishiro; Masao Iwagami; Kent Doi

doi:10.1016/j.jcrc.2024.154982

Platelet dysfunction in heatstroke-induced coagulopathy: A retrospective observational study

J Crit Care. 2024 Nov 28:85:154982. doi: 10.1016/j.jcrc.2024.154982. Online ahead of print.

Authors

Yuri Endo¹, Ryota Inokuchi², Miyuki Yamamoto¹, Ryohei Horie¹, Toshifumi Asada¹, Koichi Kashiwa³, Kazuki Fujishiro³, Masao Iwagami⁴, Kent Doi⁵

Affiliations

¹ Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
² Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; Department of Clinical Engineering, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; Department of Health Services Research, Institute of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki 305-8575, Japan.
³ Department of Clinical Engineering, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
⁴ Department of Health Services Research, Institute of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki 305-8575, Japan; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
⁵ Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; Department of Clinical Engineering, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. Electronic address: kentdoi@m.u-tokyo.ac.jp.

PMID: 39612673
DOI: 10.1016/j.jcrc.2024.154982

Abstract

Purpose: Severe heatstroke is often complicated by disseminated intravascular coagulation (DIC). The aim of this study was to evaluate platelet function assessed through thromboelastography (TEG) at the emergency department (ED) and DIC severity among patients with heatstroke.

Materials and methods: We performed a retrospective single-tertiary hospital cohort study. Patients admitted to an intensive care unit (ICU) with heatstroke were enrolled. Platelet function was evaluated as the difference between citrated functional fibrinogen-maximum amplitude (CFF-MA) and citrated rapid TEG-maximum amplitude (CRT-MA) at the ED. DIC was defined as a score ≥ 4 points based on the Japanese Association of Acute Medicine score.

Results: A total of 31 patients with heatstroke were enrolled. The median platelet count was 18.1 × 10⁴/μL, (interquartile range [IQR]: 12.6-25.0 × 10⁴/μL), and the median platelet function evaluated as CFF-MA-CRT-MA was 34.4 mm (IQR: 27.8-37.8 mm). Among several clinical and TEG-related parameters, the platelet function was strongly correlated with the DIC score (R = -0.63, p < 0.001) and significantly associated with DIC development (area under the receiver operating characteristic curve 0.87 [95 % confidence interval: 0.72-0.99]).

Conclusions: These results suggested that platelet dysfunction occurs in heatstroke-induced DIC, indicating that platelet function evaluation by TEG can provide complementary information and enhance our understanding about the subtypes of heatstroke.

Keywords: Disseminated intravascular coagulation; Heatstroke; Platelet dysfunction; Thromboelastography.