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The effect of sepsis and septic shock on the viscoelastic properties of clot quality and mass using rotational thromboelastometry: A prospective observational study

Gareth R. Davies, Matthew Lawrence, Suresh Pillai, Gavin M. Mills, Robert Aubrey, Dafydd Thomas, Rhodri Williams Orcid Logo, Keith Morris, Adrian Evans Orcid Logo

Journal of Critical Care, Volume: 44, Pages: 7 - 11

Swansea University Authors: Matthew Lawrence, Rhodri Williams Orcid Logo, Adrian Evans Orcid Logo

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DOI (Published version): 10.1016/j.jcrc.2017.09.183

Abstract

PurposeThe study purpose was to define changes in coagulation across the sepsis spectrum using rotational thromboelastometry (ROTEM).MethodsSepsis patients were recruited on admission to the Emergency Department and Intensive Care Units of a large teaching hospital in Wales. ROTEM markers of clot de...

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Published in: Journal of Critical Care
ISSN: 0883-9441
Published: Elsevier BV 2018
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URI: https://cronfa.swan.ac.uk/Record/cronfa35869
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spelling 2022-11-02T15:59:49.0857204 v2 35869 2017-10-02 The effect of sepsis and septic shock on the viscoelastic properties of clot quality and mass using rotational thromboelastometry: A prospective observational study 262d0cae7663ded863d6e2de15757f3c Matthew Lawrence Matthew Lawrence true false 642bf793695f412ed932f1ea4d9bc3f1 0000-0002-6912-5288 Rhodri Williams Rhodri Williams true false 21761f6eb805546a561c9f036e85405b 0000-0002-0814-5162 Adrian Evans Adrian Evans true false 2017-10-02 BMS PurposeThe study purpose was to define changes in coagulation across the sepsis spectrum using rotational thromboelastometry (ROTEM).MethodsSepsis patients were recruited on admission to the Emergency Department and Intensive Care Units of a large teaching hospital in Wales. ROTEM markers of clot development and fibrinolysis were determined, as well as standard coagulation markers. A healthy control group matched for age and gender was also recruited (n = 44).Results100 patients were recruited (50 sepsis, 20 severe sepsis and 30 septic shock). Maximum clot firmness was significantly higher in the sepsis (p < 0.001) and severe sepsis (p = 0.012) groups than the healthy control (71.6 ± 4.5 and 70.4 ± 4.1 vs 64.4 respectively). In septic shock there was prolonged clot development; however, maximum clot firmness remained normal. Fibrinolytic function was significantly impaired in septic shock, which was also significantly associated with 28-day mortality (p < 0.001).ConclusionsROTEM indicated significantly enhanced clot structural development in sepsis and severe sepsis, which could be indicative of a hypercoagulable phase. In septic shock, despite there being a prolongation of clotting pathways and impaired fibrinolysis, clot mass was comparably normal, suggestive of the development of a clot with healthy characteristics. Journal Article Journal of Critical Care 44 7 11 Elsevier BV 0883-9441 Sepsis; Biomarkers; Coagulation; ROTEM 1 4 2018 2018-04-01 10.1016/j.jcrc.2017.09.183 COLLEGE NANME Biomedical Sciences COLLEGE CODE BMS Swansea University 2022-11-02T15:59:49.0857204 2017-10-02T10:02:46.6035479 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Gareth R. Davies 1 Matthew Lawrence 2 Suresh Pillai 3 Gavin M. Mills 4 Robert Aubrey 5 Dafydd Thomas 6 Rhodri Williams 0000-0002-6912-5288 7 Keith Morris 8 Adrian Evans 0000-0002-0814-5162 9 0035869-02102017100452.pdf davies2017(2).pdf 2017-10-02T10:04:52.2770000 Output 744595 application/pdf Accepted Manuscript true 2018-10-02T00:00:00.0000000 true eng
title The effect of sepsis and septic shock on the viscoelastic properties of clot quality and mass using rotational thromboelastometry: A prospective observational study
spellingShingle The effect of sepsis and septic shock on the viscoelastic properties of clot quality and mass using rotational thromboelastometry: A prospective observational study
Matthew Lawrence
Rhodri Williams
Adrian Evans
title_short The effect of sepsis and septic shock on the viscoelastic properties of clot quality and mass using rotational thromboelastometry: A prospective observational study
title_full The effect of sepsis and septic shock on the viscoelastic properties of clot quality and mass using rotational thromboelastometry: A prospective observational study
title_fullStr The effect of sepsis and septic shock on the viscoelastic properties of clot quality and mass using rotational thromboelastometry: A prospective observational study
title_full_unstemmed The effect of sepsis and septic shock on the viscoelastic properties of clot quality and mass using rotational thromboelastometry: A prospective observational study
title_sort The effect of sepsis and septic shock on the viscoelastic properties of clot quality and mass using rotational thromboelastometry: A prospective observational study
author_id_str_mv 262d0cae7663ded863d6e2de15757f3c
642bf793695f412ed932f1ea4d9bc3f1
21761f6eb805546a561c9f036e85405b
author_id_fullname_str_mv 262d0cae7663ded863d6e2de15757f3c_***_Matthew Lawrence
642bf793695f412ed932f1ea4d9bc3f1_***_Rhodri Williams
21761f6eb805546a561c9f036e85405b_***_Adrian Evans
author Matthew Lawrence
Rhodri Williams
Adrian Evans
author2 Gareth R. Davies
Matthew Lawrence
Suresh Pillai
Gavin M. Mills
Robert Aubrey
Dafydd Thomas
Rhodri Williams
Keith Morris
Adrian Evans
format Journal article
container_title Journal of Critical Care
container_volume 44
container_start_page 7
publishDate 2018
institution Swansea University
issn 0883-9441
doi_str_mv 10.1016/j.jcrc.2017.09.183
publisher Elsevier BV
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
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description PurposeThe study purpose was to define changes in coagulation across the sepsis spectrum using rotational thromboelastometry (ROTEM).MethodsSepsis patients were recruited on admission to the Emergency Department and Intensive Care Units of a large teaching hospital in Wales. ROTEM markers of clot development and fibrinolysis were determined, as well as standard coagulation markers. A healthy control group matched for age and gender was also recruited (n = 44).Results100 patients were recruited (50 sepsis, 20 severe sepsis and 30 septic shock). Maximum clot firmness was significantly higher in the sepsis (p < 0.001) and severe sepsis (p = 0.012) groups than the healthy control (71.6 ± 4.5 and 70.4 ± 4.1 vs 64.4 respectively). In septic shock there was prolonged clot development; however, maximum clot firmness remained normal. Fibrinolytic function was significantly impaired in septic shock, which was also significantly associated with 28-day mortality (p < 0.001).ConclusionsROTEM indicated significantly enhanced clot structural development in sepsis and severe sepsis, which could be indicative of a hypercoagulable phase. In septic shock, despite there being a prolongation of clotting pathways and impaired fibrinolysis, clot mass was comparably normal, suggestive of the development of a clot with healthy characteristics.
published_date 2018-04-01T03:44:47Z
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