The impact of coagulation parameters on the outcomes of patients with severe community-acquired pneumonia requiring intensive care unit admission |
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Authors: | Salluh Jorge I F Rabello Ligia S C F Rosolem Maira M Soares Márcio Bozza Fernando A Verdeal Juan Carlos R Mello Gustavo W Castro Faria Neto Hugo C Lapa E Silva José Roberto Bozza Patrícia T |
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Affiliation: | aIntensive Care Unit and Postgraduate Program, Instituto Nacional de Câncer, Rio de Janeiro, Brazil 20230-130;bLaboratory of Immunopharmacology, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil 21040-360;cIntensive Care Unit, Instituto de Pesquisa Clínica Evandro Chagas, FIOCRUZ, Rio de Janeiro, Brazil 21040-360;dD'or Institute of Research and Education 22281-100;eIntensive Care Unit, Critical Care Department, Hospital Barra D'or, Rio de Janeiro, Brazil 22775-002;fPulmonary Diseases Department, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil 21941-913 |
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Abstract: | IntroductionCoagulation abnormalities are frequent in patients with severe infections. However, the predictive value of d-dimer and of the presence of associated coagulation derangements in severe community-acquired pneumonia (CAP) remains to be thoroughly evaluated. The aim of this study was to investigate the predictive value of coagulation parameters in patients with severe CAP admitted to the intensive care unit.Methodsd-Dimer, antithrombin, International Society of Thrombosis and Hemostasis score, clinical variables, Sequential Organ Failure Assessment (SOFA), The Acute Physiology and Chronic Health Evaluation II (APACHE II) and the CURB-65 score were measured in the first 24 hours. Results are shown as median (25%-75% interquartile range). The main outcome measure was hospital mortality.ResultsNinety patients with severe CAP admitted to the intensive care unit were evaluated. Overall hospital mortality was 15.5%. d-Dimer levels in nonsurvivors were higher than those in survivors. In the univariate analysis, d-dimer, SOFA, and APACHE II scores were predictors of death. The discriminative ability of d-dimer (area under receiver operating curve = 0.75 [95% confidence interval, 0.64-0.83]; best cutoff for d-dimer was 1798 ng/mL) for in-hospital mortality was comparable with APACHE II and SOFA and better than C-reactive protein. Moreover, the addition of d-dimer to APACHE II or SOFA score increased the discriminative ability of both scores (area under the receiver operating curve = 0.82 [0.72-0.89] and 0.84 [0.75-0.91], respectively).Conclusionsd-Dimer levels are good predictors of outcome in severe CAP and may augment the predictive ability of scoring systems as APACHE II and SOFA. |
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Keywords: | Abbreviations: APACHE II, The Acute Physiology and Chronic Health Evaluation II ATS, American Thoracic Society AT, antithrombin AUROC, area under the receiver operating curve CAP, community-acquired pneumonia CRP, C-reactive protein ICU, intensive care unit ICU-LOS, intensive care unit length of stay IQR, interquartile range ISTH, International Society of Thrombosis and Hemostasis MV, mechanical ventilation PSI, Pneumonia Severity Index PT, prothrombin time RCT, randomized clinical trial SOFA, Sequential Organ Failure Assessment |
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