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Coagulation in hospitalized community-acquired pneumonia: disturbances in even the least ill

Introduction

Although previous studies of severe sepsis (SS) patients found coagulopathy quite common, little is known of coagulopathy in infection with lesser degrees of illness severity.

Methods

In a 28-center prospective cohort study (GenIMS) of patients presenting to US emergency departments with community-acquired pneumonia, we measured serum coagulation markers (INR, partial thromboplastin time, platelets, antithrombin, D-dimer, factor IX, prothrombin activator-inhibitor (PAI) and thrombin–antithrombin (TAT)) on emergency department presentation. We stratified the proportion of subjects with abnormal values by illness severity (APACHE III), subsequent development of SS, and 90-day mortality. We hypothesized coagulation abnormalities would increase with illness severity and be greater in those with poor outcomes.

Results

Of 1,895 hospitalized subjects, 31% developed SS and 11% died by day 90. The proportion with abnormal initial coagulation marker values increased with initial illness severity (Figure 1). Yet, even among the least ill (APACHE III mean (SD), 31 (7); ICU admission rate 6%), coagulation abnormalities were common. Day 1 percentage abnormal PAI and TAT were greater in those that developed SS, while day 1 PAI, TAT, partial thromboplastin time, D-dimer were more often abnormal in those dying by day 90. Many subjects that either did not develop SS or died had evidence of coagulopathy at presentation (see table in Figure 1).

Figure 1
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abstract

Conclusion

Coagulation abnormalities are common in hospitalized community-acquired pneumonia patients, increasing with illness severity and poor outcome. Abnormalities were seen even in the least ill, however, and differences between groups were not large. Therapeutic manipulation of coagulation in infection will probably require a carefully titrated approach.

Acknowledgements

Supported by NIGMS R01GM61992.

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Reade, M., Milbrandt, E., Yende, S. et al. Coagulation in hospitalized community-acquired pneumonia: disturbances in even the least ill. Crit Care 12, P202 (2008). https://doi.org/10.1186/cc6423

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Keywords

  • Thrombin
  • Severe Sepsis
  • Antithrombin
  • Illness Severity
  • Partial Thromboplastin Time