Microclots, as defined by amyloid-fibrinogen aggregates, predict risks of disseminated intravascular coagulation and mortality

Mar 20, 2024Blood advances

Small protein clots linked to higher risks of widespread blood clotting and death

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Abstract

were detected in 42.3% of critically ill patients admitted to the ICU.

Microclots were present in 23 out of 44 patients with sepsis (52.3%), compared to 19 out of 60 patients without sepsis (31.7%).
Detection of microclots was accomplished using thioflavin T staining and fluorescent microscopy.
Patients with a high number or larger-sized microclots had a significantly increased likelihood of developing .
The odds ratio for developing disseminated intravascular coagulation in patients with larger microclots was 51.4.
An increased probability of 28-day mortality was associated with the presence of microclots, with an odds ratio of 5.3.

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have been associated with various conditions, including postacute sequelae of severe acute respiratory syndrome coronavirus 2 infection. They have been postulated to be amyloid-fibrin(ogen) aggregates, but their role as a prognostic biomarker remains unclear. To examine their possible clinical utility, blood samples were collected for the first 96 hours from critically ill patients (n = 104) admitted to the intensive care unit (ICU). Detection was by staining platelet-poor plasma samples with thioflavin T and visualized by fluorescent microscopy. Image J software was trained to identify and quantify microclots, which were detected in 44 patients (42.3%) on ICU admission but not in the remaining 60 (57.7%) or the 20 healthy controls (0.0%). Microclots on admission to ICU were associated with a primary diagnosis of sepsis (microclots present in sepsis, 23/44 [52.3%] vs microclots absent in sepsis, 19/60 [31.7%]; P = .044). Multicolor immunofluorescence demonstrated that microclots consisted of amyloid-fibrinogen aggregates, which was supported by proteomic analysis. Patients with either a high number or larger-sized microclots had a higher likelihood of developing (odds ratio [OR], 51.4; 95% confidence interval [CI], 6.3-6721.1; P < .001) and had an increased probability of 28-day mortality (OR, 5.3; 95% CI, 2.0-15.6; P < .001). This study concludes that microclots, as defined by amyloid-fibrin(ogen) aggregates, are potentially useful in identifying sepsis and predicting adverse coagulopathic and clinical outcomes.

Key numbers

44 of 104

Microclot Presence Rate

Patients with upon admission

51.4

for Development

Patients with high number or larger-sized

5.3

for 28-Day Mortality

Patients with compared to those without

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Microclots, as defined by amyloid-fibrinogen aggregates, predict risks of disseminated intravascular coagulation and mortality

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