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Elevated hemostasis markers after pneumonia increases one-year risk of all-cause and cardiovascular deaths

Yende, S and D'Angelo, G and Mayr, F and Kellum, JA and Weissfeld, L and Kaynar, AM and Young, T and Irani, K and Angus, DC (2011) Elevated hemostasis markers after pneumonia increases one-year risk of all-cause and cardiovascular deaths. PLoS ONE, 6 (8).

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Abstract

Background: Acceleration of chronic diseases, particularly cardiovascular disease, may increase long-term mortality after community-acquired pneumonia (CAP), but underlying mechanisms are unknown. Persistence of the prothrombotic state that occurs during an acute infection may increase risk of subsequent atherothrombosis in patients with pre-existing cardiovascular disease and increase subsequent risk of death. We hypothesized that circulating hemostasis markers activated during CAP persist at hospital discharge, when patients appear to have recovered clinically, and are associated with higher mortality, particularly due to cardiovascular causes. Methods: In a cohort of survivors of CAP hospitalization from 28 US sites, we measured D-Dimer, thrombin-antithrombin complexes [TAT], Factor IX, antithrombin, and plasminogen activator inhibitor-1 at hospital discharge, and determined 1-year all-cause and cardiovascular mortality. Results: Of 893 subjects, most did not have severe pneumonia (70.6% never developed severe sepsis) and only 13.4% required intensive care unit admission. At discharge, 88.4% of subjects had normal vital signs and appeared to have clinically recovered. D-dimer and TAT levels were elevated at discharge in 78.8% and 30.1% of all subjects, and in 51.3% and 25.3% of those without severe sepsis. Higher D-dimer and TAT levels were associated with higher risk of all-cause mortality (range of hazard ratios were 1.66-1.17, p = 0.0001 and 1.46-1.04, p = 0.001 after adjusting for demographics and comorbid illnesses) and cardiovascular mortality (p = 0.009 and 0.003 in competing risk analyses). Conclusions: Elevations of TAT and D-dimer levels are common at hospital discharge in patients who appeared to have recovered clinically from pneumonia and are associated with higher risk of subsequent deaths, particularly due to cardiovascular disease. © 2011 Yende et al.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Yende, Sspy3@pitt.eduSPY30000-0002-6596-8034
D'Angelo, G
Mayr, Fflorian@pitt.eduFLORIAN0000-0002-2298-9011
Kellum, JAkellum@pitt.eduKELLUM0000-0003-1995-2653
Weissfeld, L
Kaynar, AMkaynar@pitt.eduAMK960000-0001-8847-0450
Young, T
Irani, K
Angus, DCangusdc@pitt.eduANGUSDC0000-0002-7026-5181
Contributors:
ContributionContributors NameEmailPitt UsernameORCID
EditorBozza, Patricia T.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Date: 15 August 2011
Date Type: Publication
Journal or Publication Title: PLoS ONE
Volume: 6
Number: 8
DOI or Unique Handle: 10.1371/journal.pone.0022847
Schools and Programs: Graduate School of Public Health > Biostatistics
School of Medicine > Critical Care Medicine
Refereed: Yes
MeSH Headings: Aged; Area Under Curve; Biological Markers--blood; Cardiovascular Diseases--blood; Cardiovascular Diseases--complications; Cardiovascular Diseases--mortality; Cause of Death; Demography; Female; Hemostasis; Hospitalization; Humans; Male; Mortality; Patient Discharge; Pneumonia--blood; Pneumonia--complications; Risk Factors; Time Factors
Other ID: NLM PMC3154260
PubMed Central ID: PMC3154260
PubMed ID: 21853050
Date Deposited: 05 Sep 2012 18:52
Last Modified: 16 Nov 2020 15:55
URI: http://d-scholarship.pitt.edu/id/eprint/13886

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