COAGULATIVE BIOMARKERS DIFFERENTLY PREDICT CLINICAL OUTCOMES IN INVASIVE INFECTIONS CAUSED BY NEISSERIA MENINGITIDIS AND STREPTOCOCCUS PNEUMONIAE.

Autor:	Meini S; Internal Medicine Unit, Felice Lotti Hospital of Pontedera, Azienda Unità Sanitaria Locale Toscana Nord-Ovest, Pisa, Italy. Electronic address: simonemeini2@gmail.com., Bracalente I; Internal Medicine Unit, Felice Lotti Hospital of Pontedera, Azienda Unità Sanitaria Locale Toscana Nord-Ovest, Pisa, Italy., Sbrana F; Fondazione Toscana Gabriele Monasterio, Pisa, Italy., Ripoli A; Fondazione Toscana Gabriele Monasterio, Pisa, Italy., Andreini R; Internal Medicine Unit, Felice Lotti Hospital of Pontedera, Azienda Unità Sanitaria Locale Toscana Nord-Ovest, Pisa, Italy., Galli R; Neurology Unit, Felice Lotti Hospital of Pontedera, Azienda Unità Sanitaria Locale Toscana Nord-Ovest, Pisa, Italy., Leonardi S; Central Laboratory, Azienda Ospedaliera dei Colli, Naples, Italy., Attanasio V; First Division of Infectious Diseases, Cotugno Hospital, Azienda Ospedaliera dei Colli, Naples, Italy., Carannante N; First Division of Infectious Diseases, Cotugno Hospital, Azienda Ospedaliera dei Colli, Naples, Italy., Bernardo M; First Division of Infectious Diseases, Cotugno Hospital, Azienda Ospedaliera dei Colli, Naples, Italy., Viaggi B; Unit for Healthcare-Associated Infections in Critical Care, NeuroIntensive Care Unit, Department of Anesthesiology, Careggi University Hospital, Florence, Italy., Martini L; Infectious Disease Unit, Department of Medicine, University of Udine, Udine, Italy., Giuliano S; Infectious Disease Unit, Department of Medicine, University of Udine, Udine, Italy., Tascini C; Infectious Disease Unit, Department of Medicine, University of Udine, Udine, Italy.
Jazyk:	angličtina
Zdroj:	The American journal of medicine [Am J Med] 2024 Nov 12. Date of Electronic Publication: 2024 Nov 12.
DOI:	10.1016/j.amjmed.2024.10.020
Abstrakt:	Background: Coagulation plays a crucial role in innate immune-response to invasive infections. Coagulative biomarkers might predict clinical outcomes differently depending by etiology. Methods: A retrospective study was conducted during a 79 months period recruiting 90 patients with meningitis and/or bloodstream infection caused by Neisseria meningitidis or Streptococcus pneumoniae (47 and 43, median age 19 and 58 years, respectively). Biomarkers were assessed within 24 hours. Results: For N. meningitidis: in univariate analysis, increasing D-dimer was associated with in-hospital mortality (OR 1.360, 95% 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 non-survivors (26% vs 48%) and in patients with the composite outcome (32% vs 51%); aPTT was significantly prolonged in non-survivors (51.3 vs 35.3 seconds, p=0.003), confirmed in univariate analysis (OR 1.122, 95% CI 1.031-1.253). For S. pneumoniae: antithrombin was significantly lower in non-survivors (70% vs 81%, p=0.038), 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). Conclusions: 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. Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. (Copyright © 2024. Published by Elsevier Inc.)
Databáze:	MEDLINE
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