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The effect of sepsis and its inflammatory response on mechanical clot characteristics: a prospective observational study.

Abstract：

PURPOSE:Sepsis and its progression are known to have a major influence on the coagulation system. Current coagulation tests are of limited use when assessing coagulation in sepsis patients. This study aims to assess the potential for a new functional biomarker of clot microstructure, fractal dimension, to identify changes in the mechanical properties of clot microstructure across the sepsis spectrum (sepsis, severe sepsis and septic shock). METHODS:A total of 100 patients that presented acutely to a large teaching hospital were included in this prospective observational study (50 sepsis, 20 severe sepsis and 30 septic shock) against a matched control of 44 healthy volunteers. Fractal analysis was performed, as well as standard markers of coagulation, and six plasma markers of inflammation. RESULTS:Fractal dimension was significantly higher in the sepsis and severe sepsis groups than the healthy control (1.78 ± 0.07 and 1.80 ± 0.05, respectively vs 1.74 ± 0.03) (p < 0.001), indicating a significant increase in mechanical clot strength and elasticity consistent with a hypercoagulable state. Conversely, fractal dimension was significantly lower in septic shock (1.66 ± 0.10, p < 0.001), indicating a significant reduction in mechanical clot strength and functionality consistent with a hypocoagulable state. This corresponded with a significant increase in the inflammatory response. CONCLUSIONS:This study confirms that clot microstructure is significantly altered through the various stages of sepsis. Of particular importance was the marked change in clot development between severe sepsis and septic shock, which has not been previously reported.

journal_name

Intensive Care Med

journal_title

Intensive care medicine

authors

Davies GR,Pillai S,Lawrence M,Mills GM,Aubrey R,D'Silva L,Battle C,Williams R,Brown R,Thomas D,Morris K,Evans PA

doi

10.1007/s00134-016-4496-z

subject

Has Abstract

pub_date

2016-12-01 00:00:00

pages

1990-1998

issue

12

eissn

0342-4642

issn

1432-1238

pii

10.1007/s00134-016-4496-z

journal_volume

42

pub_type

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