The Value Of Plasma D-dimer And Fibrinogen In The Judgment Of Severity Of Community-acquired Pneumonia And Its Prognosis

Objective:Pneumonia refers to inflammation of the terminal airway,alveolar and interstitial lung caused by various pathogens,as well as physical and chemical factors,immunological damage,drugs and other factors.According to the different environment,it includes community-acquired pneumonia(CAP)and hospital-acquired pneumonia(HAP).CAP is one of the main infectious diseases,that is harmful to human healthy,and its incidence is about 12/1000.With the development of chest imaging technology,it is not difficult to diagnose CAP.But how to quickly assess the severity of patients in clinical practice,associates to the choice of treatment and the judgement of prognosis.However,the various evaluation systems recommended in the CAP guideline are too complicated to use in practice.Therefore,it is a hot spot to seek more convenient and reliable biomarkers.C-reactive protein(CRP)and procalcitonin(PCT)response rapidly in the inflammation,and they have short half-life.So,they have been widely confirmed that can be used to evaluate the severity and prognosis of CAP in time.Hemagglutination analysis is a routine laboratory test in clinical practice.D-dimer(D-Di)is degradation products of cross-linked fibrin,and its elevated level indicates hypercoagulation and secondary hyperfibrinolysis.In respiratory diseases,D-Di is currently used to diagnose and assess treatment of pulmonary embolism.Fibrinogen(FIB)is the blood coagulation factor Ⅰ,but also an important indicator of acute inflammatory.When inflammation occurs,FIB participates in producing barrier to inflammation through aggregating platelet.Recently,more and more scholars began to focus on the relationship between inflammation and coagulation.Inflammation directly orindirectly damages vascular endothelial cells(VEC),activating coagulation pathway,causing hypercoagulation,while leading to secondary hyperfibrinolysis.At present,extensive research has confirmed that sepsis patients also have the same pathological manifestations.However,whether there is D-Di and FIB abnormalities in pneumonia,which is a local infectious disease,and the application value of these two indicators in evaluating the severity and prognosis of patients is still not thoroughly researched and the results are different.The objective of this study is to investigate the clinical value of D-Di and FIB in CAP patients.Methods:81 CAP patients were collected and classify into different groups according to the following principles.a)According to the CURB-65 score were divided into low-,intermediate-,or high-risk groups.b)According to the involving segments were divided into unilateral pneumonia and bilateral pneumonia groups.c)According to parapneumonic pleural effusion were divided into not with parapneumonic pleural effusion group,combined with unilateral parapneumonic pleural effusion group,combined with bilateral parapneumonic pleural effusion group.d)According to the situation of mechanical ventilation were divided into no mechanical ventilation group and mechanical ventilation group.e)According to the outcome were divided into survival group and death group.The levels of D-Di and FIB were compared between the subgroups and the correlation with CRP and PCT were analyzed.Results:1 In the CURB-65 score low-risk group,the level of D-Di was significantly lower than the intermediate-risk group,high-risk group(P<0.05),and the difference between the intermediate-,high-risk groups was not significant(P>0.05).Compared with the bilateral pneumonia group,the level of plasma D-Di was significantly lower in the unilateral pneumonia group(P<0.05).In the not with parapneumonic pleural effusion group,the level of D-Di was significantly lower than the remaining two groups(P<0.05),but there was no statistically significant difference between combined with unilateral and bilateral parapneumonic pleural effusion group(P>0.05).Thelevel of FIB has no significant difference between every subgroups(P>0.05).2 In the no mechanical ventilation group and mechanical ventilation group,there was no significant difference about the level of D-Di and FIB(P>0.05).3 In the survival group and death group,there was no significant difference about the level of D-Di and FIB(P>0.05).4 The level of D-Di was positively correlated with CRP and PCT,the correlation coefficients were 0.459 and0.613,respectively(P<0.01).The correlation coefficient between FIB and CRP was 0.701(P<0.01),and the correlation coefficient between FIB and PCT was 0.261(P=0.05>0.01).Conclusions:1 At the 24 h of the CAP patients’ admission,the level of D-Di to a certain extent could reflect the severity of patients,but could not well reflect the clinical outcome,and the level of FIB could not reflect the severity and prognosis of patients with CAP.After reading the relevant literature,we think that dynamic monitoring may better assess its value in CAP patients.2 In CAP patients,the level of plasma D-Di and FIB was positively correlate with CRP and PCT,may become new biomarkers of pneumonia.3 There is hypercoagulation and secondary hyperfibrinolysis in CAP patients,so timely related treatment may be its important adjuvant therapy.