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Lung vessels thrombosis in hospitalized patients with community-acquired pneumonia: role of endothelial function, hemostasis, fibrinolysis and inflammation on different phases of treatment

Introduction
There are limited data on the relationship between the severity of community-acquired pneumonia (CAP), biomarkers of inflammation and coagulation as well. The aim was to evaluate the association between the severity of CAP and risk of thrombosis in patients with moderate and severe CAP. To estimate the role of parameters of systemic inflammation, endothelial dysfunction, hemostasis, coagulation on different phases of treatment.


Material and methods
The main group was 75 patients CAP. We divided the main group according severity: subgroup 1 – 41 patients with moderate CAP, subgroup 2 – 34 patients with severe CAP. Blood coagulation test, determination of biomarkers was performed at admission before starting of antibacterial treatment and after clinical stability on 7–10 day after hospitalization.


Results
We found that in both subgroup 1 and subgroup 2 the mean levels of CRP and fibrinogen were higher than in control group. Moreover, the mean level of D-dimer was significantly higher and protein C (PC) was significantly lower in both subgroups in comparison with control group. Normalization of PC is coming after 7–10 days of antibacterial treatment, vice versa ET-1, which reflects prolong endothelial dysfunction in patients with severe CAP.


Conclusions
Patients with severe CAP have the high risk of thrombosis which can be associated with endothelial dysfunction; definition of such parameters as ET-1 and PC can be useful for establishment of different coagulant disorders in patient with mild and moderate CAP, and their dynamic changes could be the initial point of prescribing or cancelling of anticoagulant treatment.