title: The impact of coagulation parameters on the outcomes of patients with severe community-acquired pneumonia requiring intensive care unit admission.
abstract: BACKGROUND
  Coagulation abnormalities are frequent in patients with severe infections. However, the predictive value of d-dimer and of the presence of associated coagulation derangements in severe community-acquired pneumonia (CAP) remains to be thoroughly evaluated. The aim of this study was to investigate the predictive value of coagulation parameters in patients with severe CAP admitted to the intensive care unit.
  
  
  METHODS
  d-Dimer, antithrombin, International Society of Thrombosis and Hemostasis score, clinical variables, Sequential Organ Failure Assessment (SOFA), The Acute Physiology and Chronic Health Evaluation II (APACHE II) and the CURB-65 score were measured in the first 24 hours. Results are shown as median (25%-75% interquartile range). The main outcome measure was hospital mortality.
  
  
  RESULTS
  Ninety patients with severe CAP admitted to the intensive care unit were evaluated. Overall hospital mortality was 15.5%. d-Dimer levels in nonsurvivors were higher than those in survivors. In the univariate analysis, d-dimer, SOFA, and APACHE II scores were predictors of death. The discriminative ability of d-dimer (area under receiver operating curve = 0.75 [95% confidence interval, 0.64-0.83]; best cutoff for d-dimer was 1798 ng/mL) for in-hospital mortality was comparable with APACHE II and SOFA and better than C-reactive protein. Moreover, the addition of d-dimer to APACHE II or SOFA score increased the discriminative ability of both scores (area under the receiver operating curve = 0.82 [0.72-0.89] and 0.84 [0.75-0.91], respectively).
  
  
  CONCLUSIONS
  d-Dimer levels are good predictors of outcome in severe CAP and may augment the predictive ability of scoring systems as APACHE II and SOFA.
authors: Intensive Care Unit and Postgraduate Program, Instituto Nacional de Câncer, Rio de Janeiro, Brazil 20230-130; Laboratory of Immunopharmacology, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil 21040-360. Electronic address: jorgesalluh@yahoo.com.br.
authors: Jorge I F
authors: JIF
authors: Salluh
authors: Intensive Care Unit and Postgraduate Program, Instituto Nacional de Câncer, Rio de Janeiro, Brazil 20230-130. Electronic address: ligiarabello@yahoo.com.br.
authors: Ligia S C F
authors: LSCF
authors: Rabello
authors: Intensive Care Unit and Postgraduate Program, Instituto Nacional de Câncer, Rio de Janeiro, Brazil 20230-130. Electronic address: mairarosalem@gmail.com.
authors: Maira M
authors: MM
authors: Rosolem
authors: Intensive Care Unit and Postgraduate Program, Instituto Nacional de Câncer, Rio de Janeiro, Brazil 20230-130. Electronic address: marciosoaresms@yahoo.com.br.
authors: Márcio
authors: M
authors: Soares
authors: Intensive Care Unit, Instituto de Pesquisa Clínica Evandro Chagas, FIOCRUZ, Rio de Janeiro, Brazil 21040-360; D'or Institute of Research and Education 22281-100. Electronic address: bozza.fernando@gmail.com.
authors: Fernando A
authors: FA
authors: Bozza
authors: Intensive Care Unit, Critical Care Department, Hospital Barra D'or, Rio de Janeiro, Brazil 22775-002. Electronic address: jverdeal@gmail.com.
authors: Juan Carlos R
authors: JCR
authors: Verdeal
authors: Intensive Care Unit, Critical Care Department, Hospital Barra D'or, Rio de Janeiro, Brazil 22775-002. Electronic address: gustavowmello@yahoo.com.br.
authors: Gustavo W
authors: GW
authors: Mello
authors: Laboratory of Immunopharmacology, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil 21040-360. Electronic address: hcastro@ioc.fiocruz.br.
authors: Hugo C
authors: HC
authors: Castro Faria Neto
authors: Pulmonary Diseases Department, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil 21941-913. Electronic address: jrlapa.ntg@terra.com.br.
authors: José Roberto
authors: JR
authors: Lapa E Silva
authors: Laboratory of Immunopharmacology, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil 21040-360. Electronic address: pbozza@gmail.com.
authors: Patrícia T
authors: PT
authors: Bozza
mesh_terms: D018806:APACHE; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000032:analysis; D017714:Community-Acquired Infections / Q000097:blood / Q000401:mortality / Q000628:therapy; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000097:blood* / Q000401:mortality / Q000628:therapy; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D