TY - JOUR
T1 - Prevalence and significance of coagulation abnormalities in community-acquired pneumonia
AU - Milbrandt, Eric B.
AU - Reade, Michael C.
AU - Lee, Minjae
AU - Shook, Stephanie L.
AU - Angus, Derek C.
AU - Kong, Lan
AU - Carter, Melinda
AU - Yealy, Donald M.
AU - Kellum, John A.
N1 - Funding Information:
We are indebted to the nurses, respira tory therapists, phlebotomists, physi cians, and other health care professionals who participated in Gen-IMS as well as the patients and their families who supported this trial. The Gen-IMS study was funded by National Institute of General Medical Sciences, National Institutes of Health grant R01 GM61992 with additional support from GlaxoSmithKline for enrollment, clinical data collection, and coagulation marker assays. SL Shook was supported by the National Institute of Health grant T32-GM074927.
PY - 2009/11
Y1 - 2009/11
N2 - Coagulation abnormalities are common in severe pneumonia and sepsis, yet little is known about the presence of coagulopathy or its significance in patients with lesser illness severity. We examined coagulation abnormalities in 939 subjects hospitalized with community-acquired pneumonia (CAP) in 28 US hospitals, hypothesizing that abnormalities would increase with illness severity and poor outcomes. We measured plasma coagulation markers (D-dimer, plasminogen activator inhibitor [PAI], antithrombin, factor IX, and thrombin-antithrombin complex [TAT]) at the time of patient presentation to the emergency department and daily during the first wk of hospitalization. Day-1 clinical laboratory test results for international normalized ratio, activated partial thromboplastin time, and platelet count were recorded from the medical record. In our cohort, 32.5% of patients developed severe sepsis and 11.1% died by d 90. Day-1 coagulation abnormalities were common, especially for D-dimer (80.6%) and TAT (36.0%), and increased with illness severity and poor outcomes. However, abnormalities also occurred in those patients who never developed organ dysfunction and differences between groups were modest. The proportion of patients with abnormalities changed over time, yet the magnitude of change was small and not always in the direction of normality. Many patients remaining in the hospital continued to manifest coagulation abnormalities on d 7, especially for D-dimer (86.5%) and TAT (36.9%). In conclusion, coagulation abnormalities were common and persistent in CAP patients, even among the least ill. These findings underscore the complexity of the coagulation response to infection and may offer insights into coagulation-based therapeutics in clinical sepsis trials.
AB - Coagulation abnormalities are common in severe pneumonia and sepsis, yet little is known about the presence of coagulopathy or its significance in patients with lesser illness severity. We examined coagulation abnormalities in 939 subjects hospitalized with community-acquired pneumonia (CAP) in 28 US hospitals, hypothesizing that abnormalities would increase with illness severity and poor outcomes. We measured plasma coagulation markers (D-dimer, plasminogen activator inhibitor [PAI], antithrombin, factor IX, and thrombin-antithrombin complex [TAT]) at the time of patient presentation to the emergency department and daily during the first wk of hospitalization. Day-1 clinical laboratory test results for international normalized ratio, activated partial thromboplastin time, and platelet count were recorded from the medical record. In our cohort, 32.5% of patients developed severe sepsis and 11.1% died by d 90. Day-1 coagulation abnormalities were common, especially for D-dimer (80.6%) and TAT (36.0%), and increased with illness severity and poor outcomes. However, abnormalities also occurred in those patients who never developed organ dysfunction and differences between groups were modest. The proportion of patients with abnormalities changed over time, yet the magnitude of change was small and not always in the direction of normality. Many patients remaining in the hospital continued to manifest coagulation abnormalities on d 7, especially for D-dimer (86.5%) and TAT (36.9%). In conclusion, coagulation abnormalities were common and persistent in CAP patients, even among the least ill. These findings underscore the complexity of the coagulation response to infection and may offer insights into coagulation-based therapeutics in clinical sepsis trials.
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UR - http://www.scopus.com/inward/citedby.url?scp=73249128178&partnerID=8YFLogxK
U2 - 10.2119/molmed.2009.00091
DO - 10.2119/molmed.2009.00091
M3 - Article
C2 - 19753144
AN - SCOPUS:73249128178
SN - 1076-1551
VL - 15
SP - 438
EP - 445
JO - Molecular Medicine
JF - Molecular Medicine
IS - 11-12
ER -