Prevalence and significance of coagulation abnormalities in community-acquired pneumonia

Milbrandt, Eric B., Reade, Michael C., Lee, MinJae, Shook, Stephanie L., Angus, Derek C., Kong, Lan, Carter, Melinda, Yealy, Donald M. and Kellum, John A. (2009) Prevalence and significance of coagulation abnormalities in community-acquired pneumonia. Molecular Medicine, 15 11-12: 438-445. doi:10.2119/molmed.2009.00091

Author Milbrandt, Eric B.
Reade, Michael C.
Lee, MinJae
Shook, Stephanie L.
Angus, Derek C.
Kong, Lan
Carter, Melinda
Yealy, Donald M.
Kellum, John A.
Title Prevalence and significance of coagulation abnormalities in community-acquired pneumonia
Journal name Molecular Medicine   Check publisher's open access policy
ISSN 1076-1551
Publication date 2009-11
Sub-type Article (original research)
DOI 10.2119/molmed.2009.00091
Open Access Status DOI
Volume 15
Issue 11-12
Start page 438
End page 445
Total pages 8
Place of publication Manhasset, NY, United States
Publisher The Feinstein Institute for Medical Research
Language eng
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.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
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