Meini Simone, Bracalente Irene, Sbrana Francesco, Ripoli Andrea, Andreini Roberto, Galli Renato, Leonardi Silvia, Attanasio Vittorio, Carannante Novella, Bernardo Mariano, Viaggi Bruno, Martini Luca, Giuliano Simone, Tascini Carlo
Internal Medicine Unit, Felice Lotti Hospital of Pontedera, Azienda Unità Sanitaria Locale Toscana Nord-Ovest, Pisa, Italy.
Internal Medicine Unit, Felice Lotti Hospital of Pontedera, Azienda Unità Sanitaria Locale Toscana Nord-Ovest, Pisa, Italy.
Am J Med. 2025 Mar;138(3):504-512. doi: 10.1016/j.amjmed.2024.10.020. Epub 2024 Nov 13.
Coagulation plays a crucial role in innate immune response to invasive infections. Coagulative biomarkers might predict clinical outcomes differently, depending on etiology.
A retrospective study was conducted during a 79-month period, recruiting 90 patients with meningitis or bloodstream infection caused by Neisseria meningitidis (n = 47) or Streptococcus pneumoniae (n = 43), median age 19 and 58 years, respectively. Biomarkers were assessed within 24 hours.
For N. meningitidis: in univariate analysis, increasing D-dimer was associated with in-hospital mortality (odds ratio [OR] 1.360; 95% confidence interval [CI], 1.063-1.889); in multivariate regression, increasing D-dimer was predictive (OR 1.037; 95% CI, 1.001-1.074) of the composite outcome (in-hospital mortality or amputations or hearing loss or neurological sequelae); protein C showed a clear trend toward lower levels in nonsurvivors (26% vs 48%) and in patients with the composite outcome (32% vs 51%); activated partial thromboplastin time (aPTT) was significantly prolonged in nonsurvivors (51.3 vs 35.3 seconds, P = .003), confirmed in univariate analysis (OR 1.122; 95% CI, 1.031-1.253). For S. pneumoniae: antithrombin was significantly lower in nonsurvivors (70% vs 81%, P = .038), confirmed in univariate analysis (OR 0.961; 95% CI, 0.921-0.997). For overall population: in multivariate regression, increasing age was associated with mortality (OR 1.043; 95% CI, 1.010-1.077), and S. pneumoniae etiology with the composite outcome (OR 6.024; 95% CI, 1.798-20.180).
For invasive infections caused by N. meningitidis, D-dimer is a biomarker capable of predicting unfavorable clinical outcomes; a potential role is suggested for aPTT prolongation and protein C decrease, and, in case of S. pneumoniae infections, for antithrombin decrease.
凝血在对侵袭性感染的固有免疫反应中起关键作用。凝血生物标志物可能根据病因不同而对临床结局有不同的预测作用。
进行了一项为期79个月的回顾性研究，招募了90例由脑膜炎奈瑟菌（n = 47）或肺炎链球菌（n = 43）引起的脑膜炎或血流感染患者，中位年龄分别为19岁和58岁。在24小时内评估生物标志物。
对于脑膜炎奈瑟菌：在单变量分析中，D - 二聚体升高与住院死亡率相关（比值比[OR] 1.360；95%置信区间[CI]，1.063 - 1.889）；在多变量回归中，D - 二聚体升高可预测（OR 1.037；95% CI，1.001 - 1.074）复合结局（住院死亡率或截肢或听力丧失或神经后遗症）；蛋白C在非幸存者（26%对48%）和有复合结局的患者（32%对51%）中呈现出明显的降低趋势；活化部分凝血活酶时间（aPTT）在非幸存者中显著延长（51.3对35.3秒，P = 0.003），单变量分析证实（OR 1.122；95% CI，1.031 - 1.253）。对于肺炎链球菌：抗凝血酶在非幸存者中显著降低（70%对81%，P = 0.038），单变量分析证实（OR 0.961；95% CI，0.921 - 0.997）。对于总体人群：在多变量回归中，年龄增长与死亡率相关（OR 1.043；95% CI，1.010 - 1.077），肺炎链球菌病因与复合结局相关（OR 6.024；95% CI，1.798 - 20.180）。
对于由脑膜炎奈瑟菌引起的侵袭性感染，D - 二聚体是一种能够预测不良临床结局的生物标志物；提示aPTT延长和蛋白C降低可能起作用，对于肺炎链球菌感染，抗凝血酶降低可能起作用。
