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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

2017; Elsevier BV; Volume: 44; Linguagem: Inglês

10.1016/j.jcrc.2017.09.183

1557-8615

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

Blood properties and coagulation

The study purpose was to define changes in coagulation across the sepsis spectrum using rotational thromboelastometry (ROTEM). Sepsis 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). 100 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). ROTEM 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.