Intensive Care Medicine

, Volume 42, Issue 12, pp 1990–1998 | Cite as

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

  • Gareth R. Davies
  • Suresh Pillai
  • Matthew Lawrence
  • Gavin M. Mills
  • Robert Aubrey
  • Lindsay D’Silva
  • Ceri Battle
  • Rhodri Williams
  • Rowan Brown
  • Dafydd Thomas
  • Keith Morris
  • Phillip Adrian Evans



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).


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.


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.


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.


Sepsis Biomarkers Coagulation Clot microstructure 



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.

Compliance with ethical standards

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.

Supplementary material

134_2016_4496_MOESM1_ESM.docx (14 kb)
Supplementary material 1 (DOCX 13 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2016

Authors and Affiliations

  • Gareth R. Davies
    • 1
    • 2
  • Suresh Pillai
    • 3
  • Matthew Lawrence
    • 1
    • 2
  • Gavin M. Mills
    • 3
  • Robert Aubrey
    • 3
  • Lindsay D’Silva
    • 1
    • 2
  • Ceri Battle
    • 1
  • Rhodri Williams
    • 5
  • Rowan Brown
    • 5
  • Dafydd Thomas
    • 6
  • Keith Morris
    • 4
  • Phillip Adrian Evans
    • 1
    • 2
    • 3
  1. 1.Haemostasis Biomedical Research Unit (HBRU)Morriston HospitalSwanseaUK
  2. 2.College of MedicineSwansea UniversitySwanseaUK
  3. 3.Emergency DepartmentABM University Health BoardSwanseaUK
  4. 4.School of Applied SciencesCardiff Metropolitan UniversityCardiffUK
  5. 5.College of EngineeringSwansea UniversitySwanseaUK
  6. 6.Cardiac Intensive Care UnitABM University Health BoardSwanseaUK

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