Pattern analysis of activated partial thromboplastin time clot waveform for detection of hemostatic changes in sepsis patients

Objectives: Coagulation is a dynamic process. Quantitative data on fibrin polymerization can be obtained by thoroughly analyzing the optical profile of the process of coagulation. This study aims to identify the changes in the activated partial thromboplastin time (APTT) clot waveform analysis (CWA) in sepsis. Materials and Methods: Blood samples of sepsis patients from the intensive care unit received for evaluation of APTT were taken for study. The samples were run in Automated Coagulation Analyzer Sysmex - coagulation system (CS) 2400, and APTT CWA was done. Statistical analysis: Statistical analysis was performed using IBM Statistical Package for the Social Sciences Statistics for Windows, version 20.0 NY. The clot waveform of APTT was analyzed in patients with sepsis. Sensitivity, specificity, positive, and negative predictive values of biphasic form in detecting disseminated intravascular coagulation (DIC) in sepsis patients were calculated. Results: A total of 133 blood samples were analyzed. Prolonged APTT was seen in 23% ( n = 44). Among the patients with prolonged APTT, 79.5% ( n = 35) cases had an altered CWA. In patients with altered CWA, 34% ( n = 45) had sepsis with an abnormal wave pattern, and 11% ( n = 15) had a biphasic waveform (BPW). DIC was diagnosed in 41% of cases ( n = 55). The APTT CWA of sepsis patients with DIC revealed abnormal wave patterns in 31% (n = 17) and biphasic waveforms (BPW) in 18% ( n = 10). The sensitivity, specificity, positive, and negative predictive values of the biphasic waveform in detecting DIC in sepsis patients were 18%, 93.5%, 66.6%, and 61.8%, respectively. Conclusions: The study demonstrated significant changes in the APTT CWA in sepsis. The presence of abnormal wave patterns in sepsis suggests liver dysfunction progressing to liver failure. A BPW in sepsis has a high specificity for DIC, which warrants immediate clinical intervention.