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Fractal analysis: a new biomarker for determining clot characteristics in critically ill patients
Critical Care, Volume: 16, Issue: S1, Start page: P430
Swansea University Authors: Gareth Davies , Sophia Stanford, Matthew Lawrence, Rhodri Williams , Adrian Evans
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DOI (Published version): 10.1186/cc11037
IntroductionRecent research  has highlighted a novel new biomarker of haemostasis: the fractal dimension (Df). This new biomarker relates the kinetics of clot formation to clot outcome in whole blood and allows us to quantify the complexity of the fibrin network microstructure which is believed t...
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IntroductionRecent research  has highlighted a novel new biomarker of haemostasis: the fractal dimension (Df). This new biomarker relates the kinetics of clot formation to clot outcome in whole blood and allows us to quantify the complexity of the fibrin network microstructure which is believed to be the template for development of the mature clot. It is well established that abnormalities in haemostasis contribute to the pathogenicity of critical illness . This prospective study aims to assess the effect of critical illness on clot structure and monitor the sensitivity of Df to therapeutic intervention.MethodsPatients with critical illness inducing SIRS were recruited on admission to the intensive therapy unit in a large teaching hospital in Wales. Blood was taken for routine coagulation testing, ROTEM thromboelastometry and rheological analysis (Df and Tgel) on admission, at 6 hours and 24 hours to assess pathophysiological state and progression. Twelve patients were recruited: nine severe sepsis and three severe DKA with metabolic disorder. Twelve healthy volunteers were recruited as a matched control.ResultsMean Df in the control group was 1.73 ± 0.03 whereas mean Df in DKA and sepsis was found to be 1.77 ± 0.07 and 1.65 ± 0.05 respectively. Marked differences were observed in Df and maximum clot firmness (MCF) in response to treatment intervention (Figure 1). Furthermore, patients saw a dramatic decrease in Df post enoxaparin, but no significant change in MCF was observed (Table 1).ConclusionDf shows specificity between severe DKA and sepsis. Df shows sensitivity to treatment intervention and illness progression in the critically ill
Fractal Dimension; Severe Sepsis; Enoxaparin; Critical Illness; Treatment Intervention
Faculty of Medicine, Health and Life Sciences