• Gareth R Davies, Matthew Lawrence, Suresh Pillai, Gavin M Mills, Robert Aubrey, Dafydd Thomas, Rhodri Williams, Keith Morris, and Phillip Adrian Evans.
• Haemostasis Biomedical Research Unit (HBRU), Morriston Hospital, Swansea, UK; College of Medicine, Swansea University, Swansea, UK.
• J Crit Care. 2018 Apr 1; 44: 7-11.

PurposeThe study purpose was to define changes in coagulation across the sepsis spectrum using rotational thromboelastometry (ROTEM).MethodsSepsis 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).Results100 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).ConclusionsROTEM 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.Copyright © 2017 Elsevier Inc. All rights reserved.

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