title: Systemic endotoxin activity correlates with clot formation: an observational study in patients with early systemic inflammation and sepsis.
abstract: BACKGROUND
  Inflammation and coagulation are closely linked, and both can be triggered by endotoxin. Thrombelastometry and impedance aggregometry are of diagnostic and predictive value in critically ill patients. In this observational study we investigated the correlation of endotoxin activity with thrombelasometric and aggregometric variables in patients with systemic inflammation.
  
  
  METHODS
  Based on a daily screening on a tertiary academic surgical ICU, patients, as soon as they fulfilled two or more criteria for systemic inflammatory response syndrome (SIRS), were included. In whole blood we performed endotoxin activity (EA) assay, thrombelastometry (ROTEM®) and impendance aggregometry (Multiplate®).
  
  
  RESULTS
  In total, 49 patients were included with a broad spread of EA levels of (median (minimum to maximum)) 0.27 (0.01 to 0.72), allowing expedient correlative analysis. Clot formation time (CFT) (263 s (60 to 1,438 s)) and clotting time (CT) (1,008 s (53 to 1,481 s)) showed a significant negative correlation with EA level (r = -0.38 (P < 0.005) and r = -0.29 (P < 0.05)). Positive correlations were found for alpha-angle (50° (17 to 78°), r = 0.40 (P < 0.005)) and maximum clot firmness (MCF) (55 mm (5/76), r = 0.27 (P < 0.05)). No significant correlations were found between Lysis Index at 60 minutes (LI60) and EA levels. There was no correlation between EA level and aggregometric values, or classical coagulation parameters.
  
  
  CONCLUSIONS
  In patients with systemic inflammation, increasing endotoxin concentrations correlate with increased clot formation.
authors.forename: Alexander
authors.initials: A
authors.lastname: Koch
authors.forename: Michael Isaäc
authors.initials: MI
authors.lastname: Meesters
authors.forename: Bertram
authors.initials: B
authors.lastname: Scheller
authors.forename: Christa
authors.initials: C
authors.lastname: Boer
authors.forename: Kai
authors.initials: K
authors.lastname: Zacharowski
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001777:Blood Coagulation / Q000502:physiology*; D001780:Blood Coagulation Tests / Q000379:methods; D004731:Endotoxins / Q000378:metabolism*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018805:Sepsis / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology; D013916:Thrombelastography / Q000379:methods
chemical_list: D004731:Endotoxins
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