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

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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.

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Acknowledgments

This study was funded by the National Institute for Social Care and Health Research (NISCHR) and was also part-funded by the European Social Fund (ESF) through the European Union’s Convergence programme administered by the Welsh Government. Our thanks go to the staff in the Emergency Department, Intensive Therapy Unit and Haemostasis Biomedical Research Unit of Morriston Hospital for their invaluable support.

Author information

Authors and Affiliations

  1. Haemostasis Biomedical Research Unit (HBRU), Morriston Hospital, Swansea, UK

    Gareth R. Davies, Matthew Lawrence, Lindsay D’Silva, Ceri Battle & Phillip Adrian Evans

  2. College of Medicine, Swansea University, Swansea, UK

    Gareth R. Davies, Matthew Lawrence, Lindsay D’Silva & Phillip Adrian Evans

  3. Emergency Department, ABM University Health Board, Swansea, UK

    Suresh Pillai, Gavin M. Mills, Robert Aubrey & Phillip Adrian Evans

  4. School of Applied Sciences, Cardiff Metropolitan University, Cardiff, UK

    Keith Morris

  5. College of Engineering, Swansea University, Swansea, UK

    Rhodri Williams & Rowan Brown

  6. Cardiac Intensive Care Unit, ABM University Health Board, Swansea, UK

    Dafydd Thomas

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  1. Gareth R. Davies
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  2. Suresh Pillai
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  3. Matthew Lawrence
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  11. Keith Morris
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Corresponding author

Correspondence to Phillip Adrian Evans.

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Conflicts of interest

PAE and PRW have signed the International Committee of Medical Journal Editors (ICMJE) form for declaration of interest and have declared all conflict of interests. All other authors declare no competing conflicts of interest.

Additional information

Take-home message: Clot microstructure is significantly altered across the sepsis spectrum. This ranges from a highly dense fibrin structure in sepsis and severe sepsis to a significantly weaker, tenuous fibrin structure in septic shock.

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Davies, G.R., Pillai, S., Lawrence, M. et al. The effect of sepsis and its inflammatory response on mechanical clot characteristics: a prospective observational study. Intensive Care Med 42, 1990–1998 (2016). https://doi.org/10.1007/s00134-016-4496-z

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  • DOI: https://doi.org/10.1007/s00134-016-4496-z

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