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Eur Respir J 2004; 24:786-789
Copyright ©ERS Journals Ltd 2004

Disturbed alveolar fibrin turnover during pneumonia is restricted to the site of infection

G. Choi1,2,3, M.J. Schultz1,3, J.W.O. van Till4, P. Bresser5, J.S. van der Zee5, M.A. Boermeester4, M. Levi2 and T. van der Poll2,3

Depts of 1 Intensive Care Medicine, 2 Internal Medicine, 3 Laboratory of Experimental Internal Medicine, 4 Surgery, and 5 Pulmonology, Academic Medical Centre, University of Amsterdam.

CORRESPONDENCE: G. Choi, Academic Medical Centre, University of Amsterdam, Dept of Intensive Care Medicine, C3-423, Meibergdreef 9, 1108 AZ, Amsterdam, the Netherlands. Fax: 31 205669568. E-mail: GodaChoi@mail.com

Keywords: Bronchoalveolar lavage fluid, coagulation, fibrinolysis, mechanical ventilation, plasma, pneumonia

Received: December 19, 2003
Accepted June 26, 2004

Severe infection is associated with profound alterations in the systemic haemostatic balance, with activation of coagulation and suppressed fibrinolysis. Within the alveolar compartment, similar disturbances have been described during pulmonary inflammation. The current authors investigated whether local haemostasis was influenced during ventilator-associated pneumonia (VAP).

In five patients with unilateral VAP, bronchoalveolar lavage fluid (BALF) was obtained from both the infected site (as identified on chest radiograph) and the contralateral noninfected lung (with no clinical or radiographic abnormalities). Markers for coagulation and fibrinolysis were compared between infected and noninfected lungs. A total of 10 healthy volunteers and 10 mechanically ventilated patients without pneumonia served as controls.

Strong activation of coagulation (high levels of thrombin-antithrombin complexes, soluble tissue factor and factor VIIa) was detected in BALF from infected lungs, compared with that from noninfected lungs and controls. Furthermore, in infected lungs, fibrinolysis was depressed, with high levels of plasminogen activator inhibitor type 1.

In conclusion, ventilator-associated pneumonia is characterised by a hypercoagulant state at the site of infection.




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