title: Prevalence and significance of coagulation abnormalities in community-acquired pneumonia.
abstract: 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.
authors.affiliation: The CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Laboratory, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, USA. milbeb@upmc.edu
authors.forename: Eric B
authors.initials: EB
authors.lastname: Milbrandt
authors.forename: Michael C
authors.initials: MC
authors.lastname: Reade
authors.forename: MinJae
authors.initials: M
authors.lastname: Lee
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Shook
authors.forename: Derek C
authors.initials: DC
authors.lastname: Angus
authors.forename: Lan
authors.initials: L
authors.lastname: Kong
authors.forename: Melinda
authors.initials: M
authors.lastname: Carter
authors.forename: Donald M
authors.initials: DM
authors.lastname: Yealy
authors.forename: John A
authors.initials: JA
authors.lastname: Kellum
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D001778:Blood Coagulation Disorders / Q000097:blood* / Q000453:epidemiology*; D001779:Blood Coagulation Factors / Q000032:analysis*; D001780:Blood Coagulation Tests; D016009:Chi-Square Distribution; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000097:blood* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D011014:Pneumonia / Q000097:blood* / Q000453:epidemiology; D015995:Prevalence; D018709:Statistics, Nonparametric
chemical_list: D015415:Biomarkers; D001779:Blood Coagulation Factors