title: Elevated hemostasis markers after pneumonia increases one-year risk of all-cause and cardiovascular deaths.
abstract: BACKGROUND
  Acceleration of chronic diseases, particularly cardiovascular disease, may increase long-term mortality after community-acquired pneumonia (CAP), but underlying mechanisms are unknown. Persistence of the prothrombotic state that occurs during an acute infection may increase risk of subsequent atherothrombosis in patients with pre-existing cardiovascular disease and increase subsequent risk of death. We hypothesized that circulating hemostasis markers activated during CAP persist at hospital discharge, when patients appear to have recovered clinically, and are associated with higher mortality, particularly due to cardiovascular causes.
  
  
  METHODS
  In a cohort of survivors of CAP hospitalization from 28 US sites, we measured D-Dimer, thrombin-antithrombin complexes [TAT], Factor IX, antithrombin, and plasminogen activator inhibitor-1 at hospital discharge, and determined 1-year all-cause and cardiovascular mortality.
  
  
  RESULTS
  Of 893 subjects, most did not have severe pneumonia (70.6% never developed severe sepsis) and only 13.4% required intensive care unit admission. At discharge, 88.4% of subjects had normal vital signs and appeared to have clinically recovered. D-dimer and TAT levels were elevated at discharge in 78.8% and 30.1% of all subjects, and in 51.3% and 25.3% of those without severe sepsis. Higher D-dimer and TAT levels were associated with higher risk of all-cause mortality (range of hazard ratios were 1.66-1.17, p = 0.0001 and 1.46-1.04, p = 0.001 after adjusting for demographics and comorbid illnesses) and cardiovascular mortality (p = 0.009 and 0.003 in competing risk analyses).
  
  
  CONCLUSIONS
  Elevations of TAT and D-dimer levels are common at hospital discharge in patients who appeared to have recovered clinically from pneumonia and are associated with higher risk of subsequent deaths, particularly due to cardiovascular disease.
authors.affiliation: The Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America. yendes@upmc.edu
authors.forename: Sachin
authors.initials: S
authors.lastname: Yende
authors.forename: Gina
authors.initials: G
authors.lastname: D'Angelo
authors.forename: Florian
authors.initials: F
authors.lastname: Mayr
authors.forename: John A
authors.initials: JA
authors.lastname: Kellum
authors.forename: Lisa
authors.initials: L
authors.lastname: Weissfeld
authors.forename: A Murat
authors.initials: AM
authors.lastname: Kaynar
authors.forename: Tammy
authors.initials: T
authors.lastname: Young
authors.forename: Kaikobad
authors.initials: K
authors.lastname: Irani
authors.forename: Derek C
authors.initials: DC
authors.lastname: Angus
mesh_terms: D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood*; D002318:Cardiovascular Diseases / Q000097:blood* / Q000150:complications / Q000401:mortality*; D002423:Cause of Death; D003710:Demography; D005260:Female; D006487:Hemostasis; D006760:Hospitalization; D006801:Humans; D008297:Male; D009026:Mortality; D010351:Patient Discharge; D011014:Pneumonia / Q000097:blood* / Q000150:complications*; D012307:Risk Factors; D013997:Time Factors
chemical_list: D015415:Biomarkers