Prevalence and Significance of Coagulation Abnormalities in Community-Acquired Pneumonia
Prevalence and Significance of Coagulation Abnormalities in Community-Acquired Pneumonia
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DOI：
10.2119/molmed.2009.00091
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发表时间：
2009-11-01
影响因子：
5.7
通讯作者：
Kellum, John A.
中科院分区：
文献类型：
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作者：
Milbrandt, Eric B.;Reade, Michael C.;Kellum, John A.
凝血功能异常在重症肺炎和脓毒症中很常见，但凝血功能障碍的存在及其在病情较轻的患者中的意义尚不清楚。我们检查了美国28家医院939名社区获得性肺炎（CAP）住院患者的凝血异常，假设异常会随着疾病严重程度和预后不良而增加。我们测量了患者在急诊科就诊时以及住院第一周每天的血浆凝血标志物（d -二聚体、纤溶酶原激活物抑制剂（PAI）、抗凝血酶、IX因子和凝血酶-抗凝血酶复合物（TAT））。从病案中记录国际标准化比率、活化部分凝血活素时间和血小板计数的第1天临床实验室检测结果。在我们的队列中，32.5%的患者出现严重败血症，11.1%的患者在90天前死亡。第1天凝血异常很常见，特别是d -二聚体（80.6%）和TAT(36.0%)，并随着病情严重程度和预后不良而增加。然而，那些从未发生器官功能障碍的患者也会出现异常，两组之间的差异不大。异常患者的比例随着时间的推移而变化，但变化的幅度很小，并不总是朝着正常的方向变化。许多留在医院的患者在第7天继续表现出凝血异常，特别是d -二聚体（86.5%）和TAT（36.9%）。总之，凝血功能异常在CAP患者中是常见和持续的，即使在病情最轻的患者中也是如此。这些发现强调了凝血对感染反应的复杂性，并可能为临床败血症试验中基于凝血的治疗方法提供见解。2009范斯坦医学研究所，www.feinsteininstitute.org在线地址：http://www.molmed.org doi: 10.2119/molmed.2009.00091
Coagulation abnormalities are common in severe pneumonia and sepsis, yet lithe 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. 2009 The Feinstein Institute for Medical Research, www.feinsteininstitute.org Online address: http://www.molmed.org doi: 10.2119/molmed.2009.00091