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

View/ open
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
2016-09-03Acceptance date
2016-08-01
Type
Article
acceptedVersion
Publisher
Springer
Metadata
Show full item recordAbstract
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
Description
Article published in Intensive Care Medicine available at https://doi.org/10.1007/s00134-016-4496-z
Collections
Related items
Showing items related by title, author, subject and abstract.
-
The effect of sepsis and septic shock on the viscoelastic properties of clot quality and mass using rotational thromboelastometry: a prospective observational study
Davies, Gareth R.; Lawrence, Matthew; Pillai, Suresh; Mills, Gavin; Aubrey, Robert; Thomas, Dafydd; Williams, Rhodri; Morris, Keith; Evans, Philip Adrian (Elsevier, 2017-10-02)Purpose: The study purpose was to define changes in coagulation across the sepsis spectrum using rotational thromboelastometry (ROTEM).Methods: Sepsis patients were recruited on admission to the Emergency Department and ... -
The Role of Whole Blood Impedance Aggregometry and Its Utilisation in the Diagnosis and Prognosis of Patients with Systemic Inflammatory Response Syndrome and Sepsis in Acute Critical Illness
Davies, Gareth R.; Mills, Gavin M.; Lawrence, Matthew; Battle, Ceri; Morris, Keith; Hawkins, Karl; Williams, Phylip R.; Davidson, Simon; Thomas, Dafydd; Evans, Phillip A. (PLoS, 2014-09-30)Objective: To assess the prognostic and diagnostic value of whole blood impedance aggregometry in patients with sepsis and SIRS and to compare with whole blood parameters (platelet count, haemoglobin, haematocrit and white ... -
The effect of different strains of LPS on the surface expression of CD14 and TLR4 in MonoMac6 cells
Raybould, David (Cardiff Metropolitan University, 2011)Toll-like Receptors (TLRs) recognise microbial pathogen-associated molecular patterns (PAMPs) and are a vital component of the innate immune system. TLR4, along with mCDl4 and MD2, recognises lipopolysaccharide (LPS) ...