Viscoelastic Coagulation Monitoring for Early Identification of Sepsis: The VISION II Study (VISION II)

Viscoelastic Coagulation Monitor as an Early Index of Sepsis in Patients Admitted With Infection at the Emergency Department: The VISION II Study

The VISION II study is a prospective, multicenter, observational cohort study evaluating the diagnostic performance of Viscoelastic Coagulation Monitor (VCM) parameters for the early identification of sepsis in adults presenting to the Emergency Department with suspected infection.The previous single-center, proof-of-concept VISION study (NCT07073456) showed that shorter clotting time (CT) was independently associated with sepsis and that patients with sepsis accumulated a greater number of out-of-range VCM measurements during follow-up. Although CT demonstrated potential for distinguishing between patients with and without sepsis, its diagnostic performance was moderate, supporting further evaluation in a larger, multicenter cohort.

Study Overview

• Status: Not yet recruiting
• Conditions: Sepsis; Infection; Sepsis-Induced Coagulopathy
• Intervention / Treatment: Diagnostic test: Viscoelastic Coagulation Monitor (VCM) testing

Detailed Description

Sepsis is frequently associated with hemostatic disturbances resulting from the close interaction between inflammation and coagulation. These alterations may occur early in the course of infection but may not be adequately detected by conventional coagulation tests. The Viscoelastic Coagulation Monitor (VCM) is a point-of-care device that provides a rapid bedside assessment of whole-blood clot formation and may therefore support the early identification of patients progressing to sepsis.

In the previous single-center, prospective, proof-of-concept VISION study, VCM parameters were evaluated in adults presenting to the Emergency Department with suspected infection. Shorter clotting time (CT) remained independently associated with sepsis after adjustment for established clinical scores and laboratory biomarkers. Patients with sepsis also accumulated a greater number of out-of-range VCM measurements during follow-up. However, the diagnostic performance of CT was moderate, indicating the need for validation in a larger, multicenter cohort. Moreover, patients receiving anticoagulant or antiplatelet therapy were excluded from the previous study, limiting the applicability of its findings to routine Emergency Department practice.

VISION II is a prospective, observational, multicenter study designed to evaluate the diagnostic performance of VCM parameters for the early identification of sepsis in approximately 400 adults presenting to the Emergency Department with suspected infection. Unlike the previous study, VISION II will include patients receiving chronic anticoagulant or antiplatelet therapy and will assess the potential effect of these treatments on VCM parameters and diagnostic performance.

VCM testing and clinical and laboratory assessments will be performed at enrollment and, for patients who remain hospitalized, at 24, 48, and 72 hours. Recorded assessments will include SOFA-2, qSOFA, NEWS2 scores, conventional coagulation parameters, inflammatory biomarkers, microbiological findings, administered antibiotic therapy, admission to the Intensive Care Unit, survival status, and major thromboembolic events.

The primary endpoint is the difference in VCM-derived parameters between patients who develop sepsis within the first 72 hours and those who do not. Sepsis will be defined according to the Sepsis-3 criteria. Sepsis status will be independently determined by two clinical adjudicators who will review the available clinical data from the 72-hour follow-up period while remaining blinded to the VCM results.

• Study Type: Observational
• Enrollment (Estimated): 400

Contacts and Locations

• Study Contact: Name: Evangelos J. Giamarellos-Bourboulis, MD, PhD; Phone Number: 00302105831994; Email: egiamarel@med.uoa.gr

Study Locations

• Greece
  • Attica
    • Magoula, Attica, Greece, 19600
      • Thriasio Eleusis General Hospital, First Department of Internal Medicine
      • Contact: Styliani Sympardi, MD, PhD; Phone Number: 00306971863078; Email: lianasympa@hotmail.com
      • Principal Investigator: Styliani Sympardi, MD, PhD
    • Nikaia, Attica, Greece, 18454
      • Nikaia General Hospital of Piraeus "Agios Panteleimon" - West Attica General Hospital "Agia Varvara", Emergency Department (ED)
      • Contact: Dimitrios Tsiftsis, MD; Phone Number: 00306945491406; Email: deltatangogr@yahoo.com
      • Principal Investigator: Dimitrios Tsiftis, MD, PhD
    • Piraeus, Attica, Greece, 18536
      • Tzaneio General Hospital of Piraeus, Emergency Department
      • Contact: Styliani Gerakari, MD, PhD; Phone Number: 00306973308684; Email: sgerakari76@gmail.com
      • Principal Investigator: Styliani Gerakari, MD, PhD
  • Central Macedonia
    • Exochí, Central Macedonia, Greece, 57010
      • G. Papanikolaou Thessaloniki General Hospital, Emergency Department
      • Contact: Eleni Peitsidou, MD, PhD; Phone Number: 00306977227355; Email: peitsidou@yahoo.gr
      • Principal Investigator: Eleni Peitsidou, MD, PhD
    • Thessaloniki, Central Macedonia, Greece, 54636
      • AHEPA Thessaloniki University General Hospital, Emergency Department
      • Contact: Varvara Fyntanidou, MD, PhD; Phone Number: 00306977427336; Email: bfyntan@yahoo.com
      • Principal Investigator: Varvara Fyntanidou, MD, PhD
  • Chaidari
    • Athens, Chaidari, Greece, 12462
      • 4th Department of Internal Medicine, ATTIKON University General Hospital, General Hospital of West Attica H Agia Varvara, National and Kapodistrian University of Athens, Medical School
      • Contact: Evangelos J. Giamarellos-Bourboulis, MD, PhD; Email: egiamarel@med.uoa.gr
      • Principal Investigator: Evangelos J. Giamarellos-Bourboulis, MD, PhD
    • Athens, Chaidari, Greece, 12462
      • Emergency Medicine Department, ATTIKON University General Hospital, General Hospital of West Attica H Agia Varvara, NKUA
      • Contact: Ioannis Parisis, MD, PhD; Phone Number: +306944322627; Email: iparissis@yahoo.com
      • Principal Investigator: Ioannis Parisis, MD, PhD
  • South Aegean
    • Ermoupoli, South Aegean, Greece, 84100
      • Syros General Hospital "Vardakeio and Proio" Department of Internal Medicine
      • Contact: Georgios Giannikopoulos, MD; Phone Number: 00306948889393; Email: giannikopoulos69@gmail.com
      • Principal Investigator: Georgios Giannikopoulos, MD
  • Thessaly
    • Larissa, Thessaly, Greece, 41221
      • General Hospital of Larissa "Koutlimpaneio and Triantafylleio"
      • Contact: Dimitrios Mpampalis, MD; Phone Number: 00306932341149; Email: dbabales@yahoo.com
      • Principal Investigator: Dimitrios Mpampalis, MD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Adult patients presenting to the Emergency Departments of participating hospitals with suspected infection who meet all inclusion criteria and none of the exclusion criteria will be enrolled in the study.

Description

Inclusion Criteria:

• Male or female adults aged 18 years or older.
• Written informed consent provided by the patient or, when the patient is unable to provide consent, by a legally authorized representative.
• Suspected infection based on the predefined diagnostic criteria for infection sources specified in the study protocol and derived from published international guidelines.

Exclusion Criteria:

• Age under 18 years.
• Written informed consent not provided by the patient or, when applicable, by a legally authorized representative.
• History of hemophilia or any other congenital coagulation disorder.
• Known hematologic malignancy, regardless of disease stage.
• Pregnancy or lactation.

Study Plan

How is the study designed?

Design Details

• Observational Models: COHORT
• Time Perspectives: PROSPECTIVE

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort

Intervention / Treatment

Patients with suspected infection; Adult patients presenting to the Emergency Department with suspected infection, as determined by the treating physician's clinical judgment and according to the predefined infection criteria specified in the study protocol.

Diagnostic test: Viscoelastic Coagulation Monitor (VCM) testing; Peripheral venous whole-blood samples will be collected for the assessment of eight parameters using the Viscoelastic Coagulation Monitor (VCM): clotting time (CT), clot formation time (CFT), alpha angle, amplitude at 10 minutes (A10), amplitude at 20 minutes (A20), maximum clot firmness (MCF), lysis index at 30 minutes (LI30), and lysis index at 45 minutes (LI45). Assessments will be performed at enrollment and, for patients who remain hospitalized, at 24, 48, and 72 hours. VCM results will not influence the patient's treatment or any other aspect of standard clinical care, which will remain entirely at the discretion of the treating physicians.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Differences in VCM parameters between patients who develop sepsis and those who do not	The eight VCM-derived parameters will be compared between patients who develop sepsis and those who do not. Sepsis will be defined according to the Sepsis-3 criteria as suspected or confirmed infection accompanied by an increase of ≥2 points in the Sequential Organ Failure Assessment (SOFA)-2 score or more from baseline.	From enrollment through 72 hours

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Clotting Time in Participants With and Without Chronic Anticoagulant or Antiplatelet Therapy	Clotting time (CT), measured in seconds using the VCM, will be summarized as median and interquartile range and compared between participants receiving chronic anticoagulant or antiplatelet therapy and participants receiving neither therapy.	From enrollment to 72 hours
Clot Formation Time in Participants With and Without Chronic Anticoagulant or Antiplatelet Therapy	Clot formation time (CFT), measured in seconds using the VCM, will be summarized as median and interquartile range and compared using the Mann-Whitney U test between participants receiving chronic anticoagulant or antiplatelet therapy and participants receiving neither therapy.	At enrollment and at 24, 48, and 72 hours
Alpha Angle in Participants With and Without Chronic Anticoagulant or Antiplatelet Therapy	Alpha angle, measured in degrees using the VCM, will be summarized as median and interquartile range and compared between participants receiving chronic anticoagulant or antiplatelet therapy and participants receiving neither therapy.	At enrollment and at 24, 48, and 72 hours.
Amplitude at 10 Minutes in Participants With and Without Chronic Anticoagulant or Antiplatelet Therapy	Amplitude at 10 minutes (A10), measured in VCM units, will be summarized as median and interquartile range and compared between participants receiving chronic anticoagulant or antiplatelet therapy and participants receiving neither therapy.	At enrollment and at 24, 48, and 72 hours.
Maximum Clot Firmness in Participants With and Without Chronic Anticoagulant or Antiplatelet Therapy	Maximum clot firmness (MCF), measured in VCM units, will be summarized as median and interquartile range and compared between participants receiving chronic anticoagulant or antiplatelet therapy and participants receiving neither therapy.	At enrollment and at 24, 48, and 72 hours.
Lysis Index at 30 Minutes in Participants With and Without Chronic Anticoagulant or Antiplatelet Therapy	Lysis index at 30 minutes (LI30), measured as a percentage using the VCM, will be summarized as median and interquartile range and compared between participants receiving chronic anticoagulant or antiplatelet therapy and participants receiving neither therapy.	At enrollment and at 24, 48, and 72 hours.
Lysis Index at 45 Minutes in Participants With and Without Chronic Anticoagulant or Antiplatelet Therapy	Lysis index at 45 minutes (LI45), measured as a percentage using the VCM, will be summarized as median and interquartile range and compared between participants receiving chronic anticoagulant or antiplatelet therapy and participants receiving neither therapy.	At enrollment and at 24, 48, and 72 hours.
Amplitude at 20 Minutes in Participants With and Without Chronic Anticoagulant or Antiplatelet Therapy	Amplitude at 20 minutes (A20), measured in VCM units, will be summarized as median and interquartile range and compared between participants receiving chronic anticoagulant or antiplatelet therapy and participants receiving neither therapy.	At enrollment and at 24, 48, and 72 hours.
Use of chronic anticoagulant therapy or antiplatelet therapy	Number and proportion of enrolled patients receiving chronic anticoagulant therapy and those not receiving anticoagulant therapy.	At enrollment
Clotting Time in Participants With and Without a Major Thromboembolic Event	Clotting time (CT), measured in seconds using the VCM, will be summarized as median and interquartile range and compared between participants who develop a major thromboembolic event and participants who do not develop such an event within the first 72 hours after enrollment.	At enrollment and at 24, 48, and 72 hours.
Clot Formation Time in Participants With and Without a Major Thromboembolic Event	Clot formation time (CFT), measured in seconds using the VCM, will be summarized as median and interquartile range and compared between participants who develop a major thromboembolic event and participants who do not develop such an event within the first 72 hours after enrollment.	At enrollment and at 24, 48, and 72 hours.
Alpha Angle in Participants With and Without a Major Thromboembolic Event	Alpha angle, measured in degrees using the VCM, will be summarized as median and interquartile range and compared between participants who experience a major thromboembolic event and participants who do not.	At enrollment and at 24, 48, and 72 hours.
Amplitude at 10 Minutes in Participants With and Without a Major Thromboembolic Event	Amplitude at 10 minutes (A10), measured in VCM units, will be summarized as median and interquartile range and compared between participants who experience a major thromboembolic event and participants who do not.	At enrollment and at 24, 48, and 72 hours.
Amplitude at 20 Minutes in Participants With and Without a Major Thromboembolic Event	Amplitude at 20 minutes (A20), measured in VCM units, will be summarized as median and interquartile range and compared between participants who experience a major thromboembolic event and participants who do not.	At enrollment and at 24, 48, and 72 hours.
Lysis Index at 30 Minutes in Participants With and Without a Major Thromboembolic Event	Lysis index at 30 minutes (LI30), measured as a percentage using the VCM, will be summarized as median and interquartile range and compared between participants who experience a major thromboembolic event and participants who do not.	At enrollment and at 24, 48, and 72 hours.
Lysis Index at 45 Minutes in Participants With and Without a Major Thromboembolic Event	Lysis index at 45 minutes (LI45), measured as a percentage using the VCM, will be summarized as median and interquartile range and compared between participants who experience a major thromboembolic event and participants who do not.	At enrollment and at 24, 48, and 72 hours.
Maximum Clot Firmness in Participants With and Without a Major Thromboembolic Event	Maximum clot firmness (MCF), measured in VCM units, will be summarized as median and interquartile range and compared between participants who experience a major thromboembolic event and participants who do not.	At enrollment and at 24, 48, and 72 hours.
Occurrence of sepsis among patients receiving chronic anticoagulant therapy	Number and proportion of patients receiving chronic anticoagulant therapy who develop sepsis, as defined by the Sepsis-3 criteria, during the study follow-up period.	From enrollment to 72 hours
Cumulative number of out-of-range VCM parameters	The cumulative number of VCM parameters outside their predefined reference ranges will be determined at enrollment and at 24, 48, and 72 hours and compared between patients who develop sepsis and those who do not.	At enrollment and at 24, 48, and 72 hours
Correlation between VCM parameters and inflammatory mediators	Correlations between the eight VCM-derived parameters and measured inflammatory mediators and biomarkers, including interleukin-6 (IL-6), tissue factor (CD142), procalcitonin (PCT), and C-reactive protein (CRP), will be assessed.	At enrollment
Correlation between VCM parameters and conventional coagulation parameters	Correlations between the eight VCM-derived parameters and conventional coagulation parameters, including international normalized ratio (INR), activated partial thromboplastin time (aPTT), fibrinogen, D-dimer levels, and platelet count, will be assessed.	At enrollment and, for hospitalized patients, at 24, 48, and 72 hours

Collaborators and Investigators

• Sponsor: Hellenic Institute for the Study of Sepsis

Study record dates

Study Major Dates

• Study Start (Estimated): November 1, 2026
• Primary Completion (Estimated): May 1, 2027
• Study Completion (Estimated): May 1, 2027

Study Registration Dates

• First Submitted: October 23, 2026
• First Submitted That Met QC Criteria: November 3, 2026
• First Posted (Actual): November 10, 2026

Study Record Updates

• Last Update Posted (Actual): November 10, 2026
• Last Update Submitted That Met QC Criteria: November 3, 2026
• Last Verified: November 1, 2026

More Information

Terms related to this study

• Keywords: Emergency Department; Sepsis; Early diagnosis; Antiplatelet therapy; Coagulation; Anticoagulant therapy; Viscoelastic Coagulation Monitor; VCM; Suspected infection; Sepsis-induced coagulopathy
• Additional Relevant MeSH Terms: Vascular Diseases; Cardiovascular Diseases; Pathologic Processes; Disease Attributes; Systemic Inflammatory Response Syndrome; Inflammation; Embolism and Thrombosis; Pathological Conditions, Signs and Symptoms; Emergencies; Thrombosis; Disease; Sepsis; Infections
• Other Study ID Numbers: VISION II

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No