Prevalence and significance of coagulation abnormalities in community-acquired pneumonia

Eric B. Milbrandt, Michael C. Reade, Minjae Lee, Stephanie L. Shook, Derek C. Angus, Lan Kong, Melinda Carter, Donald M. Yealy, John A. Kellum

Research output: Contribution to journalArticle

40 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)438-445
Number of pages8
JournalMolecular Medicine
Volume15
Issue number11-12
DOIs
StatePublished - Nov 1 2009

Fingerprint

Pneumonia
Sepsis
Plasminogen Inactivators
Factor IX
International Normalized Ratio
Antithrombins
Partial Thromboplastin Time
Platelet Count
Medical Records
Hospital Emergency Service
Hospitalization
Clinical Trials
Infection
fibrin fragment D
antithrombin III-protease complex

All Science Journal Classification (ASJC) codes

  • Molecular Medicine
  • Molecular Biology
  • Genetics
  • Genetics(clinical)

Cite this

Milbrandt, E. B., Reade, M. C., Lee, M., Shook, S. L., Angus, D. C., Kong, L., ... Kellum, J. A. (2009). Prevalence and significance of coagulation abnormalities in community-acquired pneumonia. Molecular Medicine, 15(11-12), 438-445. https://doi.org/10.2119/molmed.2009.00091
Milbrandt, Eric B. ; Reade, Michael C. ; Lee, Minjae ; Shook, Stephanie L. ; Angus, Derek C. ; Kong, Lan ; Carter, Melinda ; Yealy, Donald M. ; Kellum, John A. / Prevalence and significance of coagulation abnormalities in community-acquired pneumonia. In: Molecular Medicine. 2009 ; Vol. 15, No. 11-12. pp. 438-445.
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Milbrandt, EB, Reade, MC, Lee, M, Shook, SL, Angus, DC, Kong, L, Carter, M, Yealy, DM & Kellum, JA 2009, 'Prevalence and significance of coagulation abnormalities in community-acquired pneumonia', Molecular Medicine, vol. 15, no. 11-12, pp. 438-445. https://doi.org/10.2119/molmed.2009.00091

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.; Kellum, John A.

In: Molecular Medicine, Vol. 15, No. 11-12, 01.11.2009, p. 438-445.

Research output: Contribution to journalArticle

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AU - Reade, Michael C.

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