Coagulopathy Correlate With Outcomes In Patients With Community-Acquired Pneumonia

Objective To explore the changes of coagulation derangements in patients withcommunity-acquired pneumonia (CAP) and to evaluate the predictive value ofcoagulopathy in patients with CAP，so as to guide clinical diagnosis and treatmentbetter.Methods A retrospective study was performed in385pantients with CAP amitted toRespiratory Medical Department in the First Affiliated Hospital of XiamenUniversity，146patients admitted to the hospital were included as controls，to theexclusion of infection、tumor、trauma、thrombosis，et al. All the patients wereconsecutively included between June2010and May2011，and collected vein bloodwithin four hours.The vein blood was to measure complete blood count，4test itemsof blood coagulation，D-dimer level with the Vitek ImmunoDiagnostic Assay System.To assess clinical illness severity, the Pneumonia Severity Index (Pneumonia SeverityIndex class) were calculated in CAP patients.In order to evaluate the predictive valueof coagulopathy in patients with CAP，Our primary outcomes measure werehospital discharge or mortality.Results First，between the patients with CAP and the controls，there were nostatistical differences for age and gender (P>0.05). Secend，when the patients withCAP compared with the controls，platelets count (PLT) increased（P﹤0.05），prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen(Fib), D-dimer (D-D) significantly increased (P﹤0.001), there was no significantdifference for thrombin time (TT)(P>0.05). Patients with CAP in high-risk group(PSI grade IV-V) compared with the low-risk group (PSI grade I-III), PT、TT、D-Dwere significantly higher (P﹤0.001), and there were no significant difference inPLT、APTT、Fib (P>0.05). Third，when the patients with CAP compared with thecontrols，there were statistically significant for the abnormality of PLT、PT、APTT、Fib、D-D (P﹤0.001)，and there was no significant difference for the abnormality ofTT (P>0.05). Patients with CAP in high-risk group compared with the low-risk group，there were statistically significant for the abnormality of PLT、PT、D-D (P﹤0.05)，and there were no significant difference for the abnormality of TT、APTT、Fib(P>0.05). Fourth，patients with CAP in high-risk group compared with thelow-risk group，D-dimer was significantly higher (F=38.441, P﹤0.001), and therewas no significant difference for the abnormality of platelets count (P>0.05). Rankcorrelation was existed between D-dimer level and PSI grade.However, there was nocorrelation between the abnormality of platelets count and PSI grade. Fifth，associated with respiratory failure in patients with CAP were compared with thosewithout respiratory failure, D-dimer were significantly higher (P <0.001), and therewas no significant difference for platelet abnormality (P>0.05). Sixth，the patientswith CAP who died compared with the survival, D-dimer was significantly higher(P<0.001), and the abnormality of platelets count was significant differential (P<0.05). Seventh，the area under the receiver operator characteristic curve (ROC)ofD-dimer、PSI grade and PLT abnormality were0.962，0.906，0.583，by turns.Concerning the predictive value of mortality，both D-dimer and PSI showed idealpredictive accuracy (P<0.001)，D-dimer is more sensitive than specific. Plateletabnormalities showed poor predictive value of death.Conclusions Patients with community-acquired pneumonia combined coagulopathycommon. Plasm D-dimer was significantly higher in patients with CAP comparedwith the controls.Furthermore，positive linear correlation existed between D-dimerand the severity of CAP,higher D-dimer level indicated higher mortality.So D-dimercan be a ideal biomark to assess the severity and mortality of patients with CAP.