Clot-dynamics phenotypes in septic patients assessed with rotational thromboelastometry: a retrospective cohort study

Abstract

Sepsis is frequently accompanied by coagulopathy, but standard coagulation tests provide only a limited view of hemostatic function. In contrast, viscoelastic hemostatic assays offer real‑time assessment of clot initiation, propagation, firmness, and lysis, potentially revealing clinically relevant heterogeneity in septic coagulopathy. This study aimed to characterize clot‑dynamics phenotypes in septic patients using rotational thromboelastometry. In this retrospective cohort study, adult intensive care unit patients with sepsis or septic shock who underwent viscoelastic testing were included. Clot initiation, firmness, and lysis were categorized to generate 27 possible clot‑dynamics phenotypes. Clinical, biochemical, hematologic, and standard coagulation data were retrieved. Logistic regression was used to assess associations between viscoelastic parameters and short-term mortality. Data of 142 patients were analyzed. Thirteen of the 27 possible phenotypes were observed. Only 12% of patients demonstrated a fully normal clot‑dynamics phenotype. Clot initiation was delayed in 76 (53.5%) patients and clot firmness was increased in 47 (33.1%) patients. As far as fibrinolytic activity is concerned, 39 (27.5%) patients presented with low, whereas 34 (23.9%) with high activity. No viscoelastic parameter was associated with short-term mortality. Mortality did not differ across clot-dynamics phenotypes. Viscoelastic hemostatic assays revealed substantial heterogeneity in clot dynamics that was not captured by conventional laboratory testing. The identification of distinct phenotypes provides a foundation for future research aimed at phenotype‑guided risk stratification and individualized therapeutic strategies.