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  • Poster presentation
  • Open Access

Disturbed alveolar fibrin turnover during pneumonia is associated with reduced activated protein C levels in lungs

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Critical Care20048 (Suppl 1) :P111

  • Published:


  • Pneumonia
  • Thrombin
  • Plasminogen
  • Bronchoalveolar Lavage
  • Antithrombin


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.
Figure 1
Figure 1

Horizontal lines, median ± interquartile range from healthy (upper panels) and mechanically ventilated (lower panels) controls.


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.

Authors’ Affiliations

Academic Medical Center, Amsterdam, The Netherlands


© BioMed Central Ltd. 2004