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The state of the game is measured in 'Chaos'. Putting it simply; the more chaos you create, the more chaotic Dunwall turns out to be. The different actions Corvo takes will determine the level of chaos that engulfs the plagued city.
Things such as creating blood baths and publicly bringing and end to civilians lives will ensure chaos, whereas the opposite can be said if Corvo opts to go 'Ghost' and attempt to remain entirely undetected all the way to the end.
If the chaos level is very high, you'll encounter civilians brawling, swarms upon swarms of rats, and high levels of patrolling guards, making the game somewhat more difficult. All playthroughs differ with how chaotically the player decides to be.