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

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Author
Davies, Gareth R.
Pillai, Suresh
Lawrence, Matthew
Mills, Gavin M.
Aubrey, Robert
D'Silva, Lindsay
Battle, Ceri
Williams, Rhodri
Brown, Rowan
Thomas, Dafydd
Morris, Keith
Evans, Phillip Adrian
Date
2016-09-03
Acceptance date
2016-08-01
Type
Article
acceptedVersion
Publisher
Springer
Metadata
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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/conference proceeding
Intensive Care Medicine;
Citation
Davies, G., Pillai, S., Lawrence, M., Mills, G., Aubrey, R., D’Silva, L., Battle, C., Williams, R., Brown, R., Thomas, D., Morris, K. & Evans, P. (2016) 'The effect of sepsis and its inflammatory response on mechanical clot characteristics: a prospective observational study', Intensive Care Medicine, 42(12), pp.1990-1998
URI
http://hdl.handle.net/10369/10147
DOI
https://doi.org/10.1007/s00134-016-4496-z
Description
Article published in Intensive Care Medicine available at https://doi.org/10.1007/s00134-016-4496-z
Rights
http://www.rioxx.net/licenses/all-rights-reserved
Collections
  • Health and Risk Management [392]

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