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The effect of diabetic ketoacidosis (DKA) and its treatment on clot microstructure: Are they thrombogenic?

Suresh Pillai, Gareth Davies, Matthew Lawrence, Janet Whitley, Jeffrey Stephens Orcid Logo, Rhodri Williams Orcid Logo, Keith Morris, Adrian Evans

Clinical Hemorheology and Microcirculation, Volume: 77, Issue: 2, Pages: 183 - 194

Swansea University Authors: Janet Whitley, Jeffrey Stephens Orcid Logo, Rhodri Williams Orcid Logo, Adrian Evans

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DOI (Published version): 10.3233/ch-200957

Abstract

BACKGROUND:Diabetic ketoacidosis (DKA) is a medical emergency with a high mortality rate and is associated with severe metabolic acidosis and dehydration. DKA patients have an increased risk of arterial and venous thromboembolism, however little is known about this metabolic derangement in the first...

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Published in: Clinical Hemorheology and Microcirculation
ISSN: 1386-0291 1875-8622
Published: IOS Press 2021
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URI: https://cronfa.swan.ac.uk/Record/cronfa56196
first_indexed 2021-02-05T14:59:51Z
last_indexed 2021-06-08T03:20:17Z
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DKA patients have an increased risk of arterial and venous thromboembolism, however little is known about this metabolic derangement in the first 24 hours of admission and to assess its effect on coagulation. We therefore utilised a novel functional marker of clot microstructure (fractal dimension - df) to assess these changes within the first 24 hours. METHODS:Prospective single centre observational study to demonstrate whether the tendency of blood clot formation differs in DKA patients. RESULTS:15 DKA patients and 15 healthy matched controls were recruited. Mean df in the healthy control group was 1.74&#xB1;0.03. An elevated df of 1.78&#xB1;0.07 was observed in patients with DKA on admission. The mean pH on admission was 7.14&#xB1;0.13 and the lactate was 3.6&#xB1;2.0. df changed significantly in response to standard treatment and was significantly reduced to 1.68&#xB1;0.09 (2&#x2013;6&amp;&#x200A;h) and to 1.66&#xB1;0.08 at 24&amp;&#x200A;h (p&#x200A;&lt;&#x200A;0.01 One-way ANOVA). df also correlated significantly with lactate and pH (Pearson correlation coefficient 0.479 and &#x2013;0.675 respectively, p&#x200A;&lt;&#x200A;0.05). CONCLUSIONS:DKA patients at presentation have a densely organising less permeable thrombogenic clot microstructure as evidenced by high df. These structural changes are due to a combination of dehydration and a profound metabolic acidosis, which was reversed with treatment. These changes were not mirrored in standard clinical markers of thromboge-nicity.</abstract><type>Journal Article</type><journal>Clinical Hemorheology and Microcirculation</journal><volume>77</volume><journalNumber>2</journalNumber><paginationStart>183</paginationStart><paginationEnd>194</paginationEnd><publisher>IOS Press</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>1386-0291</issnPrint><issnElectronic>1875-8622</issnElectronic><keywords>Diabetic ketoacidosis (DKA), haemorheology, fractal dimension, gel point</keywords><publishedDay>19</publishedDay><publishedMonth>3</publishedMonth><publishedYear>2021</publishedYear><publishedDate>2021-03-19</publishedDate><doi>10.3233/ch-200957</doi><url/><notes/><college>COLLEGE NANME</college><department>Medical School</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>MEDS</DepartmentCode><institution>Swansea University</institution><apcterm/><lastEdited>2021-06-07T12:28:06.8341996</lastEdited><Created>2021-02-05T10:28:27.4884771</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>Suresh</firstname><surname>Pillai</surname><order>1</order></author><author><firstname>Gareth</firstname><surname>Davies</surname><order>2</order></author><author><firstname>Matthew</firstname><surname>Lawrence</surname><order>3</order></author><author><firstname>Janet</firstname><surname>Whitley</surname><orcid/><order>4</order></author><author><firstname>Jeffrey</firstname><surname>Stephens</surname><orcid>0000-0003-2228-086X</orcid><order>5</order></author><author><firstname>Rhodri</firstname><surname>Williams</surname><orcid>0000-0002-6912-5288</orcid><order>6</order></author><author><firstname>Keith</firstname><surname>Morris</surname><order>7</order></author><author><firstname>Adrian</firstname><surname>Evans</surname><order>8</order></author></authors><documents><document><filename>56196__19419__2d6a3339d8b4409dbfd5ecda097076a1.pdf</filename><originalFilename>56196.pdf</originalFilename><uploaded>2021-03-03T16:12:01.8186918</uploaded><type>Output</type><contentLength>356518</contentLength><contentType>application/pdf</contentType><version>Accepted Manuscript</version><cronfaStatus>true</cronfaStatus><copyrightCorrect>true</copyrightCorrect><language>eng</language></document></documents><OutputDurs/></rfc1807>
spelling 2021-06-07T12:28:06.8341996 v2 56196 2021-02-05 The effect of diabetic ketoacidosis (DKA) and its treatment on clot microstructure: Are they thrombogenic? bda7069a6ac3481b27c9986c9bc51e49 Janet Whitley Janet Whitley true false 5219d126f97f8f884bdb622099bd41de 0000-0003-2228-086X Jeffrey Stephens Jeffrey Stephens true false 642bf793695f412ed932f1ea4d9bc3f1 0000-0002-6912-5288 Rhodri Williams Rhodri Williams true false 21761f6eb805546a561c9f036e85405b Adrian Evans Adrian Evans true false 2021-02-05 MEDS BACKGROUND:Diabetic ketoacidosis (DKA) is a medical emergency with a high mortality rate and is associated with severe metabolic acidosis and dehydration. DKA patients have an increased risk of arterial and venous thromboembolism, however little is known about this metabolic derangement in the first 24 hours of admission and to assess its effect on coagulation. We therefore utilised a novel functional marker of clot microstructure (fractal dimension - df) to assess these changes within the first 24 hours. METHODS:Prospective single centre observational study to demonstrate whether the tendency of blood clot formation differs in DKA patients. RESULTS:15 DKA patients and 15 healthy matched controls were recruited. Mean df in the healthy control group was 1.74±0.03. An elevated df of 1.78±0.07 was observed in patients with DKA on admission. The mean pH on admission was 7.14±0.13 and the lactate was 3.6±2.0. df changed significantly in response to standard treatment and was significantly reduced to 1.68±0.09 (2–6& h) and to 1.66±0.08 at 24& h (p < 0.01 One-way ANOVA). df also correlated significantly with lactate and pH (Pearson correlation coefficient 0.479 and –0.675 respectively, p < 0.05). CONCLUSIONS:DKA patients at presentation have a densely organising less permeable thrombogenic clot microstructure as evidenced by high df. These structural changes are due to a combination of dehydration and a profound metabolic acidosis, which was reversed with treatment. These changes were not mirrored in standard clinical markers of thromboge-nicity. Journal Article Clinical Hemorheology and Microcirculation 77 2 183 194 IOS Press 1386-0291 1875-8622 Diabetic ketoacidosis (DKA), haemorheology, fractal dimension, gel point 19 3 2021 2021-03-19 10.3233/ch-200957 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University 2021-06-07T12:28:06.8341996 2021-02-05T10:28:27.4884771 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Suresh Pillai 1 Gareth Davies 2 Matthew Lawrence 3 Janet Whitley 4 Jeffrey Stephens 0000-0003-2228-086X 5 Rhodri Williams 0000-0002-6912-5288 6 Keith Morris 7 Adrian Evans 8 56196__19419__2d6a3339d8b4409dbfd5ecda097076a1.pdf 56196.pdf 2021-03-03T16:12:01.8186918 Output 356518 application/pdf Accepted Manuscript true true eng
title The effect of diabetic ketoacidosis (DKA) and its treatment on clot microstructure: Are they thrombogenic?
spellingShingle The effect of diabetic ketoacidosis (DKA) and its treatment on clot microstructure: Are they thrombogenic?
Janet Whitley
Jeffrey Stephens
Rhodri Williams
Adrian Evans
title_short The effect of diabetic ketoacidosis (DKA) and its treatment on clot microstructure: Are they thrombogenic?
title_full The effect of diabetic ketoacidosis (DKA) and its treatment on clot microstructure: Are they thrombogenic?
title_fullStr The effect of diabetic ketoacidosis (DKA) and its treatment on clot microstructure: Are they thrombogenic?
title_full_unstemmed The effect of diabetic ketoacidosis (DKA) and its treatment on clot microstructure: Are they thrombogenic?
title_sort The effect of diabetic ketoacidosis (DKA) and its treatment on clot microstructure: Are they thrombogenic?
author_id_str_mv bda7069a6ac3481b27c9986c9bc51e49
5219d126f97f8f884bdb622099bd41de
642bf793695f412ed932f1ea4d9bc3f1
21761f6eb805546a561c9f036e85405b
author_id_fullname_str_mv bda7069a6ac3481b27c9986c9bc51e49_***_Janet Whitley
5219d126f97f8f884bdb622099bd41de_***_Jeffrey Stephens
642bf793695f412ed932f1ea4d9bc3f1_***_Rhodri Williams
21761f6eb805546a561c9f036e85405b_***_Adrian Evans
author Janet Whitley
Jeffrey Stephens
Rhodri Williams
Adrian Evans
author2 Suresh Pillai
Gareth Davies
Matthew Lawrence
Janet Whitley
Jeffrey Stephens
Rhodri Williams
Keith Morris
Adrian Evans
format Journal article
container_title Clinical Hemorheology and Microcirculation
container_volume 77
container_issue 2
container_start_page 183
publishDate 2021
institution Swansea University
issn 1386-0291
1875-8622
doi_str_mv 10.3233/ch-200957
publisher IOS Press
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 BACKGROUND:Diabetic ketoacidosis (DKA) is a medical emergency with a high mortality rate and is associated with severe metabolic acidosis and dehydration. DKA patients have an increased risk of arterial and venous thromboembolism, however little is known about this metabolic derangement in the first 24 hours of admission and to assess its effect on coagulation. We therefore utilised a novel functional marker of clot microstructure (fractal dimension - df) to assess these changes within the first 24 hours. METHODS:Prospective single centre observational study to demonstrate whether the tendency of blood clot formation differs in DKA patients. RESULTS:15 DKA patients and 15 healthy matched controls were recruited. Mean df in the healthy control group was 1.74±0.03. An elevated df of 1.78±0.07 was observed in patients with DKA on admission. The mean pH on admission was 7.14±0.13 and the lactate was 3.6±2.0. df changed significantly in response to standard treatment and was significantly reduced to 1.68±0.09 (2–6& h) and to 1.66±0.08 at 24& h (p < 0.01 One-way ANOVA). df also correlated significantly with lactate and pH (Pearson correlation coefficient 0.479 and –0.675 respectively, p < 0.05). CONCLUSIONS:DKA patients at presentation have a densely organising less permeable thrombogenic clot microstructure as evidenced by high df. These structural changes are due to a combination of dehydration and a profound metabolic acidosis, which was reversed with treatment. These changes were not mirrored in standard clinical markers of thromboge-nicity.
published_date 2021-03-19T07:56:11Z
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score 11.102871

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