{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T17:16:41Z","timestamp":1791566201064,"version":"4.3.4"},"reference-count":26,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T00:00:00Z","timestamp":1770249600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"the Green Kou Foundation of the Zhejiang Blood Transfusion Association","award":["(ZJB-LK-2023-006)"],"award-info":[{"award-number":["(ZJB-LK-2023-006)"]}]},{"name":"the Luili Foundation of Lihuili Hospital","award":["2022YB004"],"award-info":[{"award-number":["2022YB004"]}]},{"DOI":"10.13039\/501100017594","name":"Medical and Health Science and Technology Project of Zhejiang Province","doi-asserted-by":"crossref","award":["2020KY859"],"award-info":[{"award-number":["2020KY859"]}],"id":[{"id":"10.13039\/501100017594","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>\n                    Thromboelastography (TEG) MA\/R ratio reflects coagulation status and thrombus strength. This study evaluated its prognostic value in acute respiratory failure (ARF). A retrospective analysis of 371 ARF patients admitted to the ICU, stratified by MA\/R quartiles. Outcomes included 28-day mortality, deep vein thrombosis (DVT), mechanical ventilation duration, and ICU stay. Cox proportional hazards regression model was used to assess hazard ratios, restricted cubic spline was employed to evaluate the nonlinear relationship between MA\/R and mortality, and Kaplan-Meier analysis was conducted to compare survival time across different MA\/R groups. Patients in the lowest MA\/R quartile (Q1) had significantly higher 28-day mortality (59.8% vs. 22.1\u201328.0% in Q2-Q4;\n                    <jats:italic>P<\/jats:italic>\n                    \u2009&lt;\u20090.001) and elevated inflammatory markers (cytokines, procalcitonin, lactate, creatinine; P\u2009&lt;\u20090.05). DVT incidence, ventilation duration, and ICU stay did not differ between groups. Multivariate analysis identified MA\/R as an independent mortality predictor (\n                    <jats:italic>P<\/jats:italic>\n                    \u2009&lt;\u20090.05), with mortality risk sharply increasing below a threshold of 9.7. Kaplan-Meier curves showed shorter survival in Q1 (\n                    <jats:italic>P<\/jats:italic>\n                    \u2009&lt;\u20090.001). The MA\/R ratio measured at ICU admission can rapidly identify coagulation dysfunction in patients with acute respiratory failure, with a low MA\/R ratio being a strong indicator of poor prognosis.\n                  <\/jats:p>","DOI":"10.1371\/journal.pone.0340360","type":"journal-article","created":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T18:41:42Z","timestamp":1770316902000},"page":"e0340360","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["The prognostic value of thromboelastography MA\/R ratio in predicting mortality in acute respiratory failure patients"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5333-566X","authenticated-orcid":true,"given":"Zhang-Sheng","family":"Zhao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhen-Zhen","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li-Hui","family":"Qian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"You-Li","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,2,5]]},"reference":[{"issue":"5","key":"pone.0340360.ref001","first-page":"510","article-title":"Long-term outcomes in critically ill patients with acute respiratory failure","volume":"30","author":"M Ippolito","year":"2024","journal-title":"Curr Opin Crit Care"},{"issue":"10","key":"pone.0340360.ref002","doi-asserted-by":"crossref","first-page":"3008","DOI":"10.3390\/jcm13103008","article-title":"Acute respiratory failure in autoimmune rheumatic diseases: a review","volume":"13","author":"S Poli","year":"2024","journal-title":"J Clin Med"},{"issue":"7","key":"pone.0340360.ref003","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1007\/s00134-023-07050-7","article-title":"ESICM guidelines on acute respiratory distress syndrome: definition, phenotyping and respiratory support strategies","volume":"49","author":"G Grasselli","year":"2023","journal-title":"Intensive Care Med"},{"issue":"9","key":"pone.0340360.ref004","doi-asserted-by":"crossref","first-page":"1858","DOI":"10.1183\/09031936.96.09091858","article-title":"Bronchoalveolar and systemic cytokine profiles in patients with ARDS, severe pneumonia and cardiogenic pulmonary oedema","volume":"9","author":"H Sch\u00fctte","year":"1996","journal-title":"Eur Respir J"},{"key":"pone.0340360.ref005","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.thromres.2016.11.007","article-title":"Coagulation and sepsis","volume":"149","author":"M Levi","year":"2017","journal-title":"Thromb Res"},{"issue":"4","key":"pone.0340360.ref006","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1007\/s11239-020-02174-9","article-title":"Prominent coagulation disorder is closely related to inflammatory response and could be as a prognostic indicator for ICU patients with COVID-19","volume":"50","author":"Y Liu","year":"2020","journal-title":"J Thromb Thrombolysis"},{"key":"pone.0340360.ref007","doi-asserted-by":"crossref","first-page":"1184166","DOI":"10.3389\/fmed.2023.1184166","article-title":"Association between coagulation disorder scores and in-hospital mortality in ARF patients: a retrospective analysis from the MIMIC-IV database","volume":"10","author":"Y Wu","year":"2023","journal-title":"Front Med (Lausanne)"},{"issue":"2","key":"pone.0340360.ref008","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1002\/ajh.23599","article-title":"TEG and ROTEM: technology and clinical applications","volume":"89","author":"D Whiting","year":"2014","journal-title":"Am J Hematol"},{"key":"pone.0340360.ref009","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1016\/j.amjsurg.2023.09.034","article-title":"Analysis of fibrinolytic shutdown in trauma patients with traumatic brain injury","volume":"227","author":"L Favors","year":"2024","journal-title":"Am J Surg"},{"key":"pone.0340360.ref010","doi-asserted-by":"crossref","first-page":"1076029620951847","DOI":"10.1177\/1076029620951847","article-title":"The value of thromboelastography in the diagnosis of sepsis-induced coagulopathy","volume":"26","author":"C Luo","year":"2020","journal-title":"Clin Appl Thromb Hemost"},{"issue":"2","key":"pone.0340360.ref011","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1097\/SHK.0000000000001847","article-title":"Which Septic Shock Patients With Non-Overt DIC Progress to DIC After Admission? 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