The Arteriovenous Difference in Hemostatic Parameters in Critically Ill Patients with Different Types of Energy Deficiency

Abstract

Objective: to reveal the patterns of hemostatic disorder development in the venous and arterial bed in relation to the type of energy deficiency. Subjects and methods. One hundred and ninety-nine patients who had undergone extensive abdominal surgeries (gastrectomy, pancreatoduodenectomies, hemicolectomies, hepatectomies, etc.) were examined. Among the patients, there were 5 groups: a control group without energy deficiency and 4 groups of patients who were recorded to have one of the types of energy deficiency: substrate, hypermetabolic, hypoxic, and enzymatic. Results and discussion. The nature and degree of existing metabolic disturbances and changes in the arteriovenous difference in hemostasiological parameters have a statistically proven relationship (on the basis of ROC analysis). Substrate energy deficiency was characterized by the insignificant changes in the hemostatic system as a whole, which affect only its coagulation component; the arteriovenous difference in hemostasiological parameters was similar to that in the patients without energy deficiency. In hypermetabolic energy deficiency, the venous bed demonstrated the most pronounced hemostatic changes (hypercoagulation, suppressed fibrinolysis, and enhanced platelet aggregation). The hemostatic changes that were more significant than those in the above group were responsible for the formation of a significant arteriovenous difference in the hemostasiological parameters; however, the direction of this difference did not differ from that in the patients without energy deficiency. In hypoxic energy deficiency, hemostatic disorders were heterodirectional in the arterial and venous bed (these were most marked in the arterial bed — hypercoagulation, activated fibrinolysis, and enhanced platelet aggregation) therefore there was a significant arteriovenous difference in the hemostasiological parameters, which was opposite as compared to that in the patients without energy deficiency. In enzymatic energy deficiency, the arteriovenous difference in the hemostatic parameters was slight as this deficiency was accompanied by the same hemostatic changes in the venous and arterial blood samples: hypocoagulation, thrombocytopenia, decreased platelet aggregability, and suppressed fibrinolysis. The degree of metabolic and hemostatic disorders was maximal among the considered types of energy deficiency, which was attended by a loss of the arteriovenous mechanism responsible for regulating the functional status of the hemostatic system. Key words: energy deficiency, arteriovenous difference, hemostatic system.