Journal
JOURNAL OF CRITICAL CARE
Volume 44, Issue -, Pages 7-11Publisher
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1016/j.jcrc.2017.09.183
Keywords
Sepsis; Biomarkers; Coagulation; ROTEM
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Funding
- National Institute for Social Care and Health Research (NISCHR)
- European Social Fund (ESF) through the European Union's Convergence programme
- Engineering and Physical Sciences Research Council [EP/L024799/1] Funding Source: researchfish
- EPSRC [EP/L024799/1] Funding Source: UKRI
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Purpose: The study purpose was to define changes in coagulation across the sepsis spectrum using rotational thromboelastometry (ROTEM). Methods: 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). Results: 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). Conclusions: 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. (C) 2017 Elsevier Inc. All rights reserved.
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