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

Gareth Davies Orcid Logo, Suresh Pillai, Matthew Lawrence, Gavin M. Mills, Robert Aubrey, Lindsay D´Silva, Ceri Battle, Rhodri Williams Orcid Logo, Rowan Brown Orcid Logo, Dafydd Thomas, Keith Morris, Adrian Evans Orcid Logo

Intensive Care Medicine, Volume: 42, Issue: 12, Pages: 1990 - 1998

Swansea University Authors: Gareth Davies Orcid Logo, Matthew Lawrence, Lindsay D´Silva, Rhodri Williams Orcid Logo, Rowan Brown Orcid Logo, Adrian Evans Orcid Logo

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DOI (Published version): 10.1007/s00134-016-4496-z

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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 dimens...

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Published in: Intensive Care Medicine
ISSN: 0342-4642 1432-1238
Published: Springer Science and Business Media LLC 2016
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URI: https://cronfa.swan.ac.uk/Record/cronfa30088
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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 &#xB1; 0.07 and 1.80 &#xB1; 0.05 respectively vs 1.74 &#xB1; 0.03) (p &lt; 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 &#xB1; 0.10, p &lt; 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.</abstract><type>Journal Article</type><journal>Intensive Care Medicine</journal><volume>42</volume><journalNumber>12</journalNumber><paginationStart>1990</paginationStart><paginationEnd>1998</paginationEnd><publisher>Springer Science and Business Media LLC</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>0342-4642</issnPrint><issnElectronic>1432-1238</issnElectronic><keywords>sepsis; biomarkers; cogulation; clot microstructure</keywords><publishedDay>1</publishedDay><publishedMonth>12</publishedMonth><publishedYear>2016</publishedYear><publishedDate>2016-12-01</publishedDate><doi>10.1007/s00134-016-4496-z</doi><url/><notes/><college>COLLEGE NANME</college><department>Biomedical Sciences</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>BMS</DepartmentCode><institution>Swansea University</institution><apcterm/><funders/><projectreference/><lastEdited>2022-11-02T16:08:31.0287873</lastEdited><Created>2016-09-16T13:02:35.9367597</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Medicine</level></path><authors><author><firstname>Gareth</firstname><surname>Davies</surname><orcid>0000-0002-0863-9234</orcid><order>1</order></author><author><firstname>Suresh</firstname><surname>Pillai</surname><order>2</order></author><author><firstname>Matthew</firstname><surname>Lawrence</surname><order>3</order></author><author><firstname>Gavin M.</firstname><surname>Mills</surname><order>4</order></author><author><firstname>Robert</firstname><surname>Aubrey</surname><order>5</order></author><author><firstname>Lindsay</firstname><surname>D&#xB4;Silva</surname><orcid/><order>6</order></author><author><firstname>Ceri</firstname><surname>Battle</surname><order>7</order></author><author><firstname>Rhodri</firstname><surname>Williams</surname><orcid>0000-0002-6912-5288</orcid><order>8</order></author><author><firstname>Rowan</firstname><surname>Brown</surname><orcid>0000-0003-3628-2524</orcid><order>9</order></author><author><firstname>Dafydd</firstname><surname>Thomas</surname><order>10</order></author><author><firstname>Keith</firstname><surname>Morris</surname><order>11</order></author><author><firstname>Adrian</firstname><surname>Evans</surname><orcid>0000-0002-0814-5162</orcid><order>12</order></author></authors><documents><document><filename>0030088-16092016131018.pdf</filename><originalFilename>ICM-CRONFA.pdf</originalFilename><uploaded>2016-09-16T13:10:18.8430000</uploaded><type>Output</type><contentLength>925981</contentLength><contentType>application/pdf</contentType><version>Accepted Manuscript</version><cronfaStatus>true</cronfaStatus><embargoDate>2017-09-03T00:00:00.0000000</embargoDate><copyrightCorrect>true</copyrightCorrect></document></documents><OutputDurs/></rfc1807>
spelling 2022-11-02T16:08:31.0287873 v2 30088 2016-09-16 The effect of sepsis and its inflammatory response on mechanical clot characteristics: a prospective observational study 3959a373060151515e05594d4cbcd6b1 0000-0002-0863-9234 Gareth Davies Gareth Davies true false 262d0cae7663ded863d6e2de15757f3c Matthew Lawrence Matthew Lawrence true false 01ccf114efd431d0cab9b3ef591d7f02 Lindsay D´Silva Lindsay D´Silva true false 642bf793695f412ed932f1ea4d9bc3f1 0000-0002-6912-5288 Rhodri Williams Rhodri Williams true false d7db8d42c476dfa69c15ce06d29bd863 0000-0003-3628-2524 Rowan Brown Rowan Brown true false 21761f6eb805546a561c9f036e85405b 0000-0002-0814-5162 Adrian Evans Adrian Evans true false 2016-09-16 BMS 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 Article Intensive Care Medicine 42 12 1990 1998 Springer Science and Business Media LLC 0342-4642 1432-1238 sepsis; biomarkers; cogulation; clot microstructure 1 12 2016 2016-12-01 10.1007/s00134-016-4496-z COLLEGE NANME Biomedical Sciences COLLEGE CODE BMS Swansea University 2022-11-02T16:08:31.0287873 2016-09-16T13:02:35.9367597 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Gareth Davies 0000-0002-0863-9234 1 Suresh Pillai 2 Matthew Lawrence 3 Gavin M. Mills 4 Robert Aubrey 5 Lindsay D´Silva 6 Ceri Battle 7 Rhodri Williams 0000-0002-6912-5288 8 Rowan Brown 0000-0003-3628-2524 9 Dafydd Thomas 10 Keith Morris 11 Adrian Evans 0000-0002-0814-5162 12 0030088-16092016131018.pdf ICM-CRONFA.pdf 2016-09-16T13:10:18.8430000 Output 925981 application/pdf Accepted Manuscript true 2017-09-03T00:00:00.0000000 true
title The effect of sepsis and its inflammatory response on mechanical clot characteristics: a prospective observational study
spellingShingle The effect of sepsis and its inflammatory response on mechanical clot characteristics: a prospective observational study
Gareth Davies
Matthew Lawrence
Lindsay D´Silva
Rhodri Williams
Rowan Brown
Adrian Evans
title_short The effect of sepsis and its inflammatory response on mechanical clot characteristics: a prospective observational study
title_full The effect of sepsis and its inflammatory response on mechanical clot characteristics: a prospective observational study
title_fullStr The effect of sepsis and its inflammatory response on mechanical clot characteristics: a prospective observational study
title_full_unstemmed The effect of sepsis and its inflammatory response on mechanical clot characteristics: a prospective observational study
title_sort The effect of sepsis and its inflammatory response on mechanical clot characteristics: a prospective observational study
author_id_str_mv 3959a373060151515e05594d4cbcd6b1
262d0cae7663ded863d6e2de15757f3c
01ccf114efd431d0cab9b3ef591d7f02
642bf793695f412ed932f1ea4d9bc3f1
d7db8d42c476dfa69c15ce06d29bd863
21761f6eb805546a561c9f036e85405b
author_id_fullname_str_mv 3959a373060151515e05594d4cbcd6b1_***_Gareth Davies
262d0cae7663ded863d6e2de15757f3c_***_Matthew Lawrence
01ccf114efd431d0cab9b3ef591d7f02_***_Lindsay D´Silva
642bf793695f412ed932f1ea4d9bc3f1_***_Rhodri Williams
d7db8d42c476dfa69c15ce06d29bd863_***_Rowan Brown
21761f6eb805546a561c9f036e85405b_***_Adrian Evans
author Gareth Davies
Matthew Lawrence
Lindsay D´Silva
Rhodri Williams
Rowan Brown
Adrian Evans
author2 Gareth Davies
Suresh Pillai
Matthew Lawrence
Gavin M. Mills
Robert Aubrey
Lindsay D´Silva
Ceri Battle
Rhodri Williams
Rowan Brown
Dafydd Thomas
Keith Morris
Adrian Evans
format Journal article
container_title Intensive Care Medicine
container_volume 42
container_issue 12
container_start_page 1990
publishDate 2016
institution Swansea University
issn 0342-4642
1432-1238
doi_str_mv 10.1007/s00134-016-4496-z
publisher Springer Science and Business Media LLC
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
document_store_str 1
active_str 0
description 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.
published_date 2016-12-01T03:36:43Z
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