The Changes Of Coagulation Function Of Elderly Patients With Community-acquired Pneumonia Complicated With Respiratory Failure And Its Clinical Significance

Objective:The present study aims to investigate the changes of coagulation function in elderly patients with community-acquired pneumonia(CAP) complicated with respiratory failure, the relationship between the changes of coagulation function and the severity of pneumonia, the correlation of coagulation function with White blood cell(WBC), platelet(PLT), C-reactive protein(CRP), procaicitonin(PCT), arterial parterial pressure oxygen(Pa O2), CURB-65 score, and the clinical significance of the changes of coagulation function in the development of pneumonia.Methods: Patients admitted within 24 hours of onset were enrolled and divided into pneumonia no complicated with respiratory failure group(pneumonia group), pneumonia complicated with respiratory failure(RF) group(RF group), and pneumonia complicated with multiple organ dysfunction syndrome(MODS) group(MODS group). The levels of prothrombin time(PT), activated partial thromboplastin time(APTT), fibrinogen(FIB), the plasma D-dimer(D-Dimer), WBC, PLT, CRP, PCT, and Pa O2 in peripheral blood of all enrolled elderly patients with CAP were measured, and graded by CURB-65, and compared with those of normal healthy people(control group). The correlation of coagulation function with WBC, PLT, CRP, PCT, Pa O2, CURB-65 score was also analyzed.Results: Overall, 28 patients(12 males, 16 females; mean age 75.8 ± 9.57 years) were enrolled into the pneumonia group; 27 patients(14 males, 13 females; mean age 73.8±7.59 years) into the RF group; 25 patients(15 males, 10 females; mean age 78.2±10.52 years) into the MODS group; and 23 patients(13 males, 10 females; mean age 72.6±8.56 years) into the control group. There was no significant difference in age or gender among each group(P >0.05).The peripheral level of PT was 10.04±2.37, 12.07±2.05, 13.59±2.18, and 14.99 ± 2.69, in the control, pneumonia, RF, and MODS groups, demonstrating a significant difference(F = 20.15, P = 0.0001). The level of APTT was 29.34±3.08, 31.79±3.78, 33.79±3.46, and 36.59±3.90, in the four groups, demonstrating a significant difference(F = 17.86, P = 0.0001). The level of FIB was 3.98±1.03, 4.87±1.59, 3.17±1.18, and 2.41±1.07, in the four groups, demonstrating a significant difference(F = 18.87, P = 0.0001). The level of D-Dimer was 0.30±0.21, 0.53±0.23, 0.84±0.27, 1.45±0.35, in the four groups, demonstrating a significant difference(F = 83.79, P = 0.0001). The level of WBC was 8.57±3.23, 11.57±3.51, 13.89±4.02, 17.04±3.93, in the four groups, demonstrating a significant difference(F = 22.81, P = 0.0001). The level of PLT was 235.71±51.02, 265.31±53.67, 187.45±45.72, 126.04±42.69, in the four groups, demonstrating a significant difference(F = 40.74, P = 0.0001). The level of CRP was 6.02±1.76, 59.82±27.61, 89.51±34.15, 108.53 ± 37.06, in the four groups, demonstrating a significant difference(F = 14.77, P = 0.0001). The level of PCT was 0.29±0.15, 6.06±3.68, 10.35 ± 4.49, 21.76 ± 5.34, in the four groups, demonstrating a significant difference(F = 83.87, P = 0.0001). The level of Pa O2 was 84.15±7.14, 75.48 ± 5.79, 51.68 ± 6.94, 49.73 ± 7.08, in the four groups, demonstrating a significant difference(F = 136.61,P = 0.0001). The level of CURB-65 score was 1.04±0.21, 1.57±0.44, 3.18±0.40, 4.40±0.55, in the four groups, demonstrating a significant difference(F = 303.17, P = 0.0001).Changes in PT, APTT, FIB, D-Dimer, WBC, PLT, CRP, PCT, and Pa O2 levels before and after treatment in the pneumonia, RF, and MODS groups: The peripheral PT levels after treatment were 10.34±1.45, 11.59±1.93, 13.08±2.16, in the pneumonia, RF, and MODS groups. Compared with before treament results have significant differences. The APTT levels after treatment were 29.46±2.35, 31.07±4.12, 33.28±4.35, in the three groups. Compared with before treament results have significant differences. The FIB levels after treatment were 3.79±1.39, 4.02±1.29, 3.26±1.24, in the three groups. Compared with before treament results have significant differences. The D-Dimer levels after treatment were 0.41±0.18, 0.68±0.24, 1.17±0.42, in the three groups. Compared with before treament results have significant differences. The WBC levels after treatment were 6.07±2.74, 6.75±3.12, 13.24±2.94, in the three groups. Compared with before treament results have significant differences. The PLT levels after treatment were 235.48±48.67, 219.73±55.78, 153.59±48.34, in the three groups. Compared with before treament results have significant differences. The CRP levels after treatment were 6.53±3.94, 12.38±5.24, 20.72±8.42, in the three groups. Compared with before treament results have significant differences. The PCT levels after treatment were 0.32±0.14, 2.12±1.04, 4.32±1.46, in the three groups. Compared with before treament results have significant differences. The Pa O2 levels after treatment were 83.46±8.13, 79.41±10.14, 65.79±10.52, in the three groups. Compared with before treament results have significant differences.Correlation of coagulation function with WBC, PLT, CRP, PCT, Pa O2, and CURB-65 score in the elderly CAP patients: The peripheral PT level was significantly positively correlated with WBC, CRP, PCT, and CURB-65 score(r = 0.522, P = 0.003; r = 0.375, P = 0.041; r = 0.500, P = 0.005; r = 0.544, P = 0.002) in the elderly CAP patients, and was significantly negatively correlated with Pa O2(r =-0.517, P = 0.003). The peripheral APTT level was significantly positively correlated with WBC, PCT, and CURB-65 score(r = 0.401, P = 0.028; r = 0.413, P = 0.023; r = 0.503, P = 0.005), and was significantly negatively correlated with PLT and Pa O2(r =-0.496, P = 0.005; r =-0.443, P = 0.014). The peripheral FIB level was significantly positively correlated with PLT and Pa O2(r = 0.613, P = 0.000; r = 0.476, P = 0.08), and was significantly negatively correlated with PCT and CURB-65 score(r =-0.596, P = 0.001; r =-0.624, P = 0.000). The peripheral D-Dimer level was significantly positively correlated with WBC, CRP, PCT, and CURB-65 score(r = 0.518, P = 0.003; r = 0.361, P = 0.050; r = 0.570, P = 0.001; r = 0.580, P = 0.001), and was significantly negatively correlated with PLT and Pa O2(r =-0.516, P = 0.004; r =-0.479, P = 0.007).Conclusion: The levels of PT, APTT, FIB, and D-Dimer in peripheral blood of elderly CAP patients no complicated with RF were increased. With the exacerbation of the disease, the levels of PT, APTT, and D-Dimer in peripheral blood of patients complicated with RF and MODS got higher, and the levle of FIB decreased obviously. The function of blood coagulation is correlated with the severity of elderly CAP, and is an important predictor of mortality in patients with severe pneumonia. Targeted intervention and control of peripheral coagulation function in the elderly CAP patients will become a new idea and method of anti-infective treatment of lung diseases, which will improve the accuracy of diagnosis and the prognosis of patients.