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.

doi:10.2119/molmed.2009.00091

Cited by 126 publications

(111 citation statements)

References 43 publications

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“…About 90% of inpatients with pneumonia had increased coagulation activity, marked by increased d-dimer concentrations. 25 In this study, we found d-dimer greater than 1 µg/mL is associated with fatal outcome of COVID-19. High levels of d-dimer have a reported asso ciation with 28-day mortality in patients with infection or sepsis identified in the emergency department.…”

Section: Discussionmentioning

confidence: 51%

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

et al. 2020

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Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. MethodsIn this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratoryconfirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients).Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03-1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61-12·23; p<0·0001), and d-dimer greater than 1 µg/mL (18·42, 2·64-128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0-24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days.Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 µg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future.

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Section: Discussionmentioning

confidence: 51%

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

et al. 2020

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“…INR was elevated at day 0, and significantly decreased over time. INR improvement in patients treated with TCZ should be considered as a positive result since an elevated INR is usually associated with more severe cases of bacterial and viral pneumonia [29].…”

Section: Discussionmentioning

confidence: 99%

Tocilizumab for Treatment of Severe COVID-19 Patients: Preliminary Results from SMAtteo COvid19 REgistry (SMACORE)

et al. 2020

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Objective: This study aimed to assess the role of Tocilizumab therapy (TCZ) in terms of ICU admission and mortality rate of critically ill patients with severe COVID-19 pneumonia. Design: Patients with COVID-19 pneumonia were prospectively enrolled in SMAtteo COvid19 REgistry (SMACORE). A retrospective analysis of patients treated with TCZ matched using propensity score to patients treated with Standard Of Care (SOC) was conducted. Setting: The study was conducted at IRCCS Policlinico San Matteo Hospital, Pavia, Italy, from March 14, 2020 to March 27, 2020. Participants: Patients with a confirmed diagnosis of COVID-19 hospitalized in our institution at the time of TCZ availability. Interventions: TCZ was administered to 21 patients. The first administration was 8 mg/kg (up to a maximum 800 mg per dose) of Tocilizumab intravenously, repeated after 12 h if no side effects were reported after the first dose. Main Outcomes and Measures: ICU admission and 7-day mortality rate. Secondary outcomes included clinical and laboratory data. Results: There were 112 patients evaluated (82 were male and 30 were female, with a median age of 63.55 years). Using propensity scores, the 21 patients who received TCZ were matched to 21 patients who received SOC (a combination of hydroxychloroquine, azithromycin and prophylactic dose of low weight heparin). No adverse event was detected following TCZ administration. This study found that treatment with TCZ did not significantly affect ICU admission (OR 0.11; 95% CI between 0.00 and 3.38; p = 0.22) or 7-day mortality rate (OR 0.78; 95% CI between 0.06 and 9.34; p = 0.84) when compared with SOC. Analysis of laboratory measures showed significant interactions between time and treatment regarding C-Reactive Protein (CRP), alanine aminotransferase (ALT), platelets and international normalized ratio (INR) levels. Variation in lymphocytes count was observed over time, irrespective of treatment. Conclusions: TCZ administration did not reduce ICU admission or

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“…Details of the study design, eligibility criteria, and clinical definitions have been published elsewhere (26–30). Briefly, we enrolled subjects >18 years old, who had a clinical and radiological diagnosis of pneumonia per criteria of Fine et al (31), and provided informed consent directly or by proxy.…”

Section: Methodsmentioning

confidence: 99%

Understanding the potential role of statins in pneumonia and sepsis*

Yende

Milbrandt

Kellum

et al. 2011

Critical Care Medicine

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Objective To examine the association of statin use with clinical outcomes and circulating biomarkers in community-acquired pneumonia (CAP) and sepsis. Design Multicenter inception cohort study. Setting Emergency departments of 28 US hospitals. Patients 1895 subjects hospitalized with CAP. Interventions None. Measurements and Main Results Our approach consisted of two different comparison cohorts, each reflecting methods used in prior publications in this area. We first compared subjects with prior statin use (prior use cohort), defined as a history of statin use in the week before admission, to those with no prior use. We then compared prior statin users whose statins were continued in-hospital (continued use cohort) to those with either no prior use or no inhospital use. We adjusted for patient characteristics, including demographics, comorbid conditions, and illness severity, and accounted for healthy user effect and indication bias using propensity analysis. We determined risk of severe sepsis and 90-day mortality. We measured markers inflammation (TNF, IL-6, IL-10), coagulation (antithrombin, Factor IX, plasminogen activator inhibitor, D-dimer, thrombin antithrombin complex), and lymphocyte cell surface protein expression during first week of hospitalization. There were no differences in severe sepsis risk between statin users and non-users for prior (30.8% vs. 30.7%, p=0.98) or continued statin use (30.2% vs. 30.8%, p=0.85) in univariate analyses, and after adjusting for patient characteristics and propensity for statin use. Ninety-day mortality was similar in prior statin users (9.2% vs. 12.0%, p=0.11) and lower in continued statin users (7.9% vs. 12.1%, p=0.02). After adjusting for patient characteristics and propensity for statin use, there was no mortality benefit for prior (OR=0.90 (0.63–1.29), p=0.57) or continued statin use (OR=0.73 (0.47–1.13), p=0.15). Only antithrombin activity over time was higher in statin subjects, yet the magnitude of difference was modest. There were no differences in other coagulation, inflammatory, or lymphocyte cell surface markers. Conclusions We found no evidence of a protective effect for statin use on clinical outcomes and only modest differences in circulating biomarkers in CAP, perhaps due to healthy user effects and indication bias.

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Prevalence and Significance of Coagulation Abnormalities in Community-Acquired Pneumonia

Cited by 126 publications

References 43 publications

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Tocilizumab for Treatment of Severe COVID-19 Patients: Preliminary Results from SMAtteo COvid19 REgistry (SMACORE)

Understanding the potential role of statins in pneumonia and sepsis*

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