title: Disturbed alveolar fibrin turnover during pneumonia is restricted to the site of infection.
abstract: Severe infection is associated with profound alterations in the systemic haemostatic balance, with activation of coagulation and suppressed fibrinolysis. Within the alveolar compartment, similar disturbances have been described during pulmonary inflammation. The current authors investigated whether local haemostasis was influenced during ventilator-associated pneumonia (VAP). In five patients with unilateral VAP, bronchoalveolar lavage fluid (BALF) was obtained from both the infected site (as identified on chest radiograph) and the contralateral noninfected lung (with no clinical or radiographic abnormalities). Markers for coagulation and fibrinolysis were compared between infected and noninfected lungs. A total of 10 healthy volunteers and 10 mechanically ventilated patients without pneumonia served as controls. Strong activation of coagulation (high levels of thrombin-antithrombin complexes, soluble tissue factor and factor VIIa) was detected in BALF from infected lungs, compared with that from noninfected lungs and controls. Furthermore, in infected lungs, fibrinolysis was depressed, with high levels of plasminogen activator inhibitor type 1. In conclusion, ventilator-associated pneumonia is characterised by a hypercoagulant state at the site of infection.
authors.affiliation: Dept of Intensive Care Medicine, Academic Medical Centre, University of Amsterdam, C3-423, Meibergdreef 9, 1108 AZ, Amsterdam, the Netherlands. GodaChoi@mail.com
authors.forename: G
authors.initials: G
authors.lastname: Choi
authors.forename: M J
authors.initials: MJ
authors.lastname: Schultz
authors.forename: J W O
authors.initials: JW
authors.lastname: van Till
authors.forename: P
authors.initials: P
authors.lastname: Bresser
authors.forename: J S
authors.initials: JS
authors.lastname: van der Zee
authors.forename: M A
authors.initials: MA
authors.lastname: Boermeester
authors.forename: M
authors.initials: M
authors.lastname: Levi
authors.forename: T
authors.initials: T
authors.lastname: van der Poll
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000990:Antithrombin III / Q000032:analysis; D001992:Bronchoalveolar Lavage Fluid; D015942:Factor VIIa / Q000032:analysis; D005260:Female; D005337:Fibrin / Q000378:metabolism*; D005342:Fibrinolysis / Q000502:physiology; D006487:Hemostasis; D006801:Humans; D008168:Lung / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D010447:Peptide Hydrolases / Q000032:analysis; D017395:Plasminogen Activator Inhibitor 1 / Q000032:analysis; D011014:Pneumonia / Q000378:metabolism* / Q000503:physiopathology / Q000628:therapy; D012122:Ventilators, Mechanical
chemical_list: D017395:Plasminogen Activator Inhibitor 1; C046193:antithrombin III-protease complex; D000990:Antithrombin III; D005337:Fibrin; D010447:Peptide Hydrolases; D015942:Factor VIIa