Thromboelastography in Acute Immunologic Reactions. A Prospective Pilot Study.

Introduction Biomarkers of fibrinolysis are elevated during acute immunologic reactions, although it is unclear whether fibrinolysis is associated with disease severity.We investigated a possible association between maximum lysis (ML) measured by thromboelastography and the severity of acute immunologic reactions. Materials and Methods We recruited patients with immunologic reactions at a high-volume emergency department. Clinical disease severity at presentation and at the end of the emergency department stay was assessed using a 5-grade scale, ranging from local symptoms to cardiac arrest. We determined ML on admission by thromboelastography (ROTEM®, EXTEM and APTEM tests), expressed as ML%. Hyperfibrinolysis was defined as an ML>15% in EXTEM, which was reversed by adding aprotinin (APTEM). We used exact logistic regression to investigate an association between ML% and disease severity (grades 1-2 (mild) vs. 3-5 (severe)) and between hyperfibrinolysis and disease severity. Results We included 31 patients (71% female, median age 52 (IQR 35-58) years, 10 (32%) with a severe reaction). ML% was higher in patients with severe (21 (12-100) vs. 10 (4-17)) symptoms. Logistic regression found a significant association between ML% and symptom severity (odds ratio (OR) 1.07, 95% confidence interval (CI) 1.014-1.206, p=0.003). Hyperfibrinolysis was detected in 6 patients and found to be associated with severe symptoms (OR 17.59 (95% CI 1.52-991.09, p=0.015).D-dimer, tryptase, and IgE concentrations increased with the severity of immunologic reactions. Conclusions Maximum lysis, quantified by thromboelastography, is associated with the severity of acute immunologic reactions.