Systemic endotoxin activity correlates with clot formation: An observational study in patients with early systemic inflammation and sepsis

Alexander Koch, Michael I. Meesters, Bertram Scheller, Christa Boer, Kai Zacharowski

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Introduction: 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.

Original languageEnglish
Article numberR198
JournalCritical Care
Volume17
Issue number5
DOIs
Publication statusPublished - 11 Sep 2013

Cite this

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title = "Systemic endotoxin activity correlates with clot formation: An observational study in patients with early systemic inflammation and sepsis",
abstract = "Introduction: 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{\circledR}) and impendance aggregometry (Multiplate{\circledR}).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.",
author = "Alexander Koch and Meesters, {Michael I.} and Bertram Scheller and Christa Boer and Kai Zacharowski",
year = "2013",
month = "9",
day = "11",
doi = "10.1186/cc12892",
language = "English",
volume = "17",
journal = "Critical Care",
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Systemic endotoxin activity correlates with clot formation : An observational study in patients with early systemic inflammation and sepsis. / Koch, Alexander; Meesters, Michael I.; Scheller, Bertram; Boer, Christa; Zacharowski, Kai.

In: Critical Care, Vol. 17, No. 5, R198, 11.09.2013.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Systemic endotoxin activity correlates with clot formation

T2 - An observational study in patients with early systemic inflammation and sepsis

AU - Koch, Alexander

AU - Meesters, Michael I.

AU - Scheller, Bertram

AU - Boer, Christa

AU - Zacharowski, Kai

PY - 2013/9/11

Y1 - 2013/9/11

N2 - Introduction: 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.

AB - Introduction: 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.

UR - http://www.scopus.com/inward/record.url?scp=84883618551&partnerID=8YFLogxK

U2 - 10.1186/cc12892

DO - 10.1186/cc12892

M3 - Article

VL - 17

JO - Critical Care

JF - Critical Care

SN - 1466-609X

IS - 5

M1 - R198

ER -