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Disturbed alveolar fibrin turnover during pneumonia is associated with reduced activated protein C levels in lungs
Critical Care volume 8, Article number: P111 (2004)
In pneumonia alveolar fibrin turnover is disturbed by activation of coagulation and inhibition of fibrinolysis. The role of natural coagulation inhibitors, such as activated protein C (APC), in lung inflammation is unknown.
In nine patients with unilateral pneumonia (four community-acquired [CAP], five ventilator associated [VAP]) bronchoalveolar lavage fluid (BALF) was obtained from both the infected and the contralateral noninfected lung. BALF levels of coagulation (thrombin–antithrombin complex [TATc]), fibrinolysis (plasminogen activator activity [PAA]), and levels of APC were determined. Ten healthy subjects and 10 mechanically ventilated patients without pneumonia served as controls.
The Wilcoxon signed-ranked test was used for paired samples from the same patients; the Mann–Whitney U test was used for comparisons with controls.
Higher levels of TATc and lower levels of PAA were found in infected lungs compared with noninfected lungs and lungs from controls (P < 0.05). Protein C and APC concentrations were significantly decreased at the infected site (P < 0.01). See Fig. 1.
Pneumonia is characterized by a strong procoagulant shift at the site of infection, caused by local activation of coagulation, inhibition of fibrinolysis, and low levels of APC.
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Choi, G., Bresser, P., Levi, M. et al. Disturbed alveolar fibrin turnover during pneumonia is associated with reduced activated protein C levels in lungs. Crit Care 8 (Suppl 1), P111 (2004). https://doi.org/10.1186/cc2578