title: The effect of sepsis and its inflammatory response on mechanical clot characteristics: a prospective observational study.
abstract: OBJECTIVE
  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.
authors: Haemostasis Biomedical Research Unit (HBRU), Morriston Hospital, Swansea, UK.|College of Medicine, Swansea University, Swansea, UK.
authors: Gareth R
authors: GR
authors: Davies
authors: Emergency Department, ABM University Health Board, Swansea, UK.
authors: Suresh
authors: S
authors: Pillai
authors: Haemostasis Biomedical Research Unit (HBRU), Morriston Hospital, Swansea, UK.|College of Medicine, Swansea University, Swansea, UK.
authors: Matthew
authors: M
authors: Lawrence
authors: Emergency Department, ABM University Health Board, Swansea, UK.
authors: Gavin M
authors: GM
authors: Mills
authors: Emergency Department, ABM University Health Board, Swansea, UK.
authors: Robert
authors: R
authors: Aubrey
authors: Haemostasis Biomedical Research Unit (HBRU), Morriston Hospital, Swansea, UK.|College of Medicine, Swansea University, Swansea, UK.
authors: Lindsay
authors: L
authors: D'Silva
authors: Haemostasis Biomedical Research Unit (HBRU), Morriston Hospital, Swansea, UK.
authors: Ceri
authors: C
authors: Battle
authors: College of Engineering, Swansea University, Swansea, UK.
authors: Rhodri
authors: R
authors: Williams
authors: College of Engineering, Swansea University, Swansea, UK.
authors: Rowan
authors: R
authors: Brown
authors: Cardiac Intensive Care Unit, ABM University Health Board, Swansea, UK.
authors: Dafydd
authors: D
authors: Thomas
authors: School of Applied Sciences, Cardiff Metropolitan University, Cardiff, UK.
authors: Keith
authors: K
authors: Morris
authors: Haemostasis Biomedical Research Unit (HBRU), Morriston Hospital, Swansea, UK. phillip.evans2@wales.nhs.uk.|College of Medicine, Swansea University, Swansea, UK. phillip.evans2@wales.nhs.uk.|Emergency Department, ABM University Health Board, Swansea, UK. phillip.evans2@wales.nhs.uk.
authors: Phillip Adrian
authors: http://orcid.org/0000-0002-0814-5162
authors: PA
authors: Evans
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D001777:Blood Coagulation / Q000502:physiology*; D001778:Blood Coagulation Disorders / Q000097:blood; D016022:Case-Control Studies; D003198:Computer Simulation; D004636:Emergency Service, Hospital; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005340:Fibrinogen / Q000032:analysis*; D017709:Fractals; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008855:Microscopy, Electron, Scanning; D008875:Middle Aged; D011446:Prospective Studies; D018805:Sepsis / Q000097:blood*
chemical_list: D015415:Biomarkers; D005340:Fibrinogen
keywords: Biomarkers; Clot microstructure; Coagulation; Sepsis