Diagnostic role of systemic inflammation, blood coagulation and padua prediction score in lung thrombosis risk estimation in hospitalized patients with community-acquired pneumonia

Abstract

OBJECTIVE: Introduction: Some coagulation and thrombotic disorders during severe CAP could lead to some intravascular disorders and even be the reason of lethal end in hospitalized patients with CAP. But this fact hadn't been established to the end yet. The aim was to study the intravascular changes in patients with severe CAP and to estimate the role of parameters of systemic inflammation (procalcitonin (PCT), C-reactive protein (CRP)), blood coagulation test (fibrinogen, D-dimer, heparin time, prothrombin time) and risk of thrombosis in patients with moderate and severe CAP. PATIENTS AND METHODS: Materials and methods: The main group was 63 patients with moderate to severe CAP. The mean age was 54.0 [37.0-63.0] years old, men - 46 (73.0%)). Depending on the severity all patients of the main group were divided into 2 subgroups: subgroup 1 - 36 patients with moderate CAP (the mean age was 51.0 [32.5-62.5] years old, men - 29 (80.5%)), subgroup 2 - 27 patients with severe CAP (the mean age was 56.0 [46.0-68.0] years old, men - 17 (63.0%). Subgroups had no significant difference according to age (p=0,348) and sex (p=0,237). Received results were compared with values in control group. The control group was 10 healthy people (the mean age was 52.0 [35.6-62.0] years old, men - 5 (50.0%)). RESULTS: Results and conclusions: Patients with severe CAP had significantly higher levels of PCT, CRP, D-dimer, prothrombin time, heparin index and the lowest level of heparin time. This fact shows the highest risk of thrombosis in patients with severe CAP on the background of severe systemic inflammation. The mean level of scores by Padua scale in patients with severe CAP was 5.0 [5.0-6.0] scores, which was significantly higher than in patients with moderate CAP, who had 1.0 [1.0-2.0] scores. On autopsy of 5 died patients with severe CAP we found thrombosis of lung vessels which differ from embolism or post-mortem blood clots. These changes maybe reflect systemic thrombosis at patients with severe CAP and could be the reasons of increased mortality in this category of patients.