The Role of Serum Coagulation Factors in the Differential Diagnosis of Patients with Pneumonia and Parapneumonic Effusion

Abstract

The aim of this study was to identify the participations of the serum coagulations and fibrinolysis factors that contribute to the differential diagnosis of the patients with community-acquired pneumonia (CAP) without effusion, uncomplicated parapneumonic effusion (UCPPE) and complicated parapneumonic effusion (CPPE). The coagulations system is fundamental for the maintenance of homeostasis, and contributes to the inflammatory process responsible for CAP and the parapneumonic effusion. The factors of coagulations and fibrinolysis participate in the cellular proliferation and migration as in the synthesis of the inflammatory mediators. We evaluated the laboratory profile of coagulations and fibrinolysis in the serum of 148 patients with CAP without effusion, 50 with UCPPE and 44 with CPPE. We determined the test of the coagulation cascade which measures the time elapsed from the activation of the coagulation cascade at different points to the fibrin generation. As a consequence, there is an activation of the fibrinolytic system with the increased D-dimer levels measured in the plasma in the three groups. The patients were with mean age ± SD (53,82 ± 17,5) min - max 18-93 years. A significantly higher number of thrombocytes was in the group with CPPE with median 412 × 109/L (rank 323-513 × 109/L). The extended activation of the prothrombin time (aPTT) was significantly higher in the same group of patients with median of 32 sec. (rank 30-35 sec). The mean D-dimer plasma level was 3266,5 ± 1292,3 ng/ml in patients with CPPE, in CAP without effusion 1646,6 ± 1204 ng/ml and in UCPPE 1422,9 ± 970 ng/ml. The coagulations system and the fibrinolysis play important role in the development and pathophysiology of CAP and the parapneumonic effusions.

Mean platelet volume and D-dimer as predictors for complicated community-acquired pneumonia in hospitalized children

“…Inflammationcoagulation imbalance plays an important role in the formation of parapneumonic effusion and lung necrotization. The results of prior research coincide with the findings of this study, which found that complicated CAP patients had significantly raised D-dimer levels, indicating a disturbance of coagulation and fibrinolysis in the development of complicated pneumonia [16,17].…”

Value of D-dimer in predicting various clinical outcomes following community-acquired pneumonia: A network meta-analysis

“…All included studies were observational. Two [ 47 , 55 ] of them were multicenter and eleven [ 31 , 33 , 34 , 37 , 39 , 42 , 43 , 45 , 48 , 54 , 55 ] were prospective observational studies. Five studies [ 32 , 33 , 38 , 39 , 41 ] reported d-dimer levels of different severity by class I to class V so that we combined means and standard deviation (SD) into two groups (severe CAP VS Non-severe CAP) by StatsToDo.…”

“…Cut-off values were determined as 500 or 1000 ng/mL in 7 studies [ 33 , 41 , 48 , 53 , 56 – 58 ]. ELISA method was used in 7 studies [ 34 , 35 , 38 , 43 , 45 , 48 , 59 ]; immunoturbidimetric methods were used in 7 studies [ 31 , 36 , 37 , 40 , 44 , 53 , 60 ] and quantitative latex assay were launched in six studies [ 32 , 37 , 39 , 41 , 55 , 57 ]. The rest of included studies only reported D-dimer kit, automatic analytical instrument, but not revealed their assay methods.…”

“…QUIPS tool had been used to assess the quality of included studies ( Table 2 ). Among all the 32 studies, 20 were high risk of bias [ 11 , 31 , 32 , 34 , 35 , 37 – 42 , 44 , 49 , 54 – 56 , 58 – 61 ], 2 studies were evaluated as low risk of bias [ 43 , 53 ] and the remaining 10 studies had medium risk of bias. The number of individual domains rated as high risk ranged from 0 to 3.…”

“…We excluded one study [ 59 ] for quantitative synthesis because it simply defined severe CAP as pneumonia with pleural effusion. Twelve studies [ 11 , 31 , 32 , 34 , 35 , 37 – 43 ] including 1,394 participants reported the plasma d-dimer level of both severe CAP and non-severe CAP patients. Pooled effect size (ES) suggested d-dimer level was significantly higher in severe CAP patients than non-severe CAP patients with great heterogeneity (SMD = 1.21 95%CI 0.87–1.56, I 2 = 86.8% p = 0.000) ( Fig 2 ) and pooled result with adjusted OR [ 36 , 43 ] (OR = 1.07 95%CI 1.01–1.13, I 2 = 60.2% p = 0.113) was consistent with continuous data ( S1 Fig ).…”