ORIGINAL ARTICLESThromboelastometric prediction of mortality using the kinetics of clot growth in critically ill septic patientsScărlătescu, Ecaterinaa; Lancé, Marcus D.b; White, Nathan J.c; Tomescu, Dana R.a,dAuthor Information aDepartment of Anaesthesia and Intensive Care, Fundeni Clinical Institute, Bucharest, Romania bDepartment of Anesthesiology, ICU and Perioperative Medicine, Hamad Medical Corporation, Doha, Qatar cDepartment of Emergency Medicine, University of Washington, Seattle, Washington, USA dUniversity of Medicine and Pharmacy Carol Davila, Bucharest, Romania Correspondence to Ecaterina Scărlătescu, Department of Anaesthesia and Intensive Care, Fundeni Clinical Institute, 258 Fundeni Street, 022328 Bucharest, Romania Tel: +40 743127924; e-mail: email@example.com Received 26 February, 2018 Revised 16 June, 2018 Accepted 26 June, 2018 Blood Coagulation & Fibrinolysis: September 2018 - Volume 29 - Issue 6 - p 533-539 doi: 10.1097/MBC.0000000000000757 Buy Metrics Abstract Sepsis induces alterations in blood coagulation which are associated with mortality. Using rotational thromboelastometry (ROTEM), these states are often characterized by changes in parameters representing terminal clot lysis. However, the ROTEM changes are often subtle, making them difficult to recognize and interpret. The objective of this study is to evaluate a new ROTEM clot velocity parameter representing clot formation kinetics in septic ICU patients. We hypothesized that this time-based parameter was significantly different in critically ill septic survivors vs. nonsurvivors. This retrospective observational study included severe sepsis and septic shock patients having a minimum of two organ dysfunctions by Sequential Organ Failure Assessment criteria (study group), and a control group of healthy adults without infection . ROTEM with EXTEM activation was performed in all groups. The time from maximal clot formation velocity to zero velocity, representing the latter portion of time during active clot formation prior to achieving maximal clot firmness (t-AUCi) was calculated along with other ROTEM parameters and compared between septic survivors, nonsurvivors and healthy controls. A total of 76 septic patients, of which 26.3%, survived, were included in the study group, and 26 healthy control individuals were included in the control group. t-AUCi correlated with terminal clot lysis (P < 0.001), and was significantly prolonged in septic nonsurvivors compared with survivors and healthy controls (P < 0.001). t-AUCi also differentiated nonsurvivors vs. survivors among those patients having similar ROTEM lysis indices. t-AUCi was useful to differentiate critically ill septic patients, and could be useful to identify septic patients with high-risk of ICU mortality. Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.