Background and objectiveCommunity-acquired pneumonia (CAP) is associated with an increased risk of arterial and venous thrombosis but the underlying pathophysiological mechanisms are still unclear. We investigated if, in patients with CAP, a pro-thrombotic state does exist and its relationship with serum levels of endotoxins. MethodsA total of 104 consecutive patients with CAP were prospectively recruited and followed up until discharge. At admission and at discharge, serum endotoxins, systemic markers of clotting activation and zonulin, a marker of gut permeability, were analysed. Hospitalized patients matched for gender, age and comorbidities but without infections were used as control. ResultsAt admission, CAP patients showed higher plasma levels of F-1 (+2), a marker of thrombin generation (P=0.023), and lower levels of protein C (PC; P<0.001) and activated PC (aPC) (P<0.001) compared with controls. At discharge, plasma levels of both PC and aPC significantly increased while F-1 (+2) significantly decreased (P<0.001). Baseline serum endotoxins and zonulin were higher in CAP patients than controls (P<0.001) and significantly decreased at discharge; a significant correlation between serum endotoxins and zonulin was detected (R=0.575; P<0.001) ConclusionThis study provides the first evidence that CAP patients disclose an ongoing pro-thrombotic state and suggests a role for endotoxemia in determining enhanced thrombin generation. Community-acquired pneumonia (CAP) is associated with an increased risk of arterial and venous thrombosis, but the underlying pathophysiological mechanisms are unclear. This study provides the first evidence that CAP patients disclose an ongoing pro-thrombotic state and suggests a role for endotoxemia in determining enhanced thrombin generation.
Low-grade endotoxemia and clotting activation in the early phase of pneumonia
Ferroni P;
2016-01-01
Abstract
Background and objectiveCommunity-acquired pneumonia (CAP) is associated with an increased risk of arterial and venous thrombosis but the underlying pathophysiological mechanisms are still unclear. We investigated if, in patients with CAP, a pro-thrombotic state does exist and its relationship with serum levels of endotoxins. MethodsA total of 104 consecutive patients with CAP were prospectively recruited and followed up until discharge. At admission and at discharge, serum endotoxins, systemic markers of clotting activation and zonulin, a marker of gut permeability, were analysed. Hospitalized patients matched for gender, age and comorbidities but without infections were used as control. ResultsAt admission, CAP patients showed higher plasma levels of F-1 (+2), a marker of thrombin generation (P=0.023), and lower levels of protein C (PC; P<0.001) and activated PC (aPC) (P<0.001) compared with controls. At discharge, plasma levels of both PC and aPC significantly increased while F-1 (+2) significantly decreased (P<0.001). Baseline serum endotoxins and zonulin were higher in CAP patients than controls (P<0.001) and significantly decreased at discharge; a significant correlation between serum endotoxins and zonulin was detected (R=0.575; P<0.001) ConclusionThis study provides the first evidence that CAP patients disclose an ongoing pro-thrombotic state and suggests a role for endotoxemia in determining enhanced thrombin generation. Community-acquired pneumonia (CAP) is associated with an increased risk of arterial and venous thrombosis, but the underlying pathophysiological mechanisms are unclear. This study provides the first evidence that CAP patients disclose an ongoing pro-thrombotic state and suggests a role for endotoxemia in determining enhanced thrombin generation.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
