Document Detail

Abnormal coagulation tests obtained in the emergency department are associated with mortality in patients with suspected infection.
MedLine Citation:
PMID:  20542399     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Early recognition of acute organ dysfunction in emergency department (ED) patients with suspected infection may help select patients at increased risk of mortality. The hematologic system is often overlooked in the evaluation and management of patients with infection because it is poorly circumscribed and serves a multitude of functions.
STUDY OBJECTIVES: We examine the hypothesis that abnormalities in commonly and easily obtained markers of coagulation function (international normalized ratio [INR], partial thromboplastin time [PTT], and platelet count [PLT]) are associated with mortality in ED patients admitted to the hospital with suspected infection.
DESIGN: Secondary analysis of a prospective observational cohort study.
SETTING: Urban tertiary care university hospital with 50,000 annual ED visits.
PATIENTS: Included patients: adults (age 18 ≥ years) evaluated in the ED for a suspected infection, had an INR, PTT, and PLT obtained during the ED stay, admitted to the hospital. Excluded patients: on oral anticoagulant therapy, received heparin, or pre-existing severe liver disease.
RESULTS: There were 1688 patients included. The in-hospital mortality rate was 5.9%. After adjusting for elderly status, comorbid illness burden, and severity of illness, elevated INR was associated with a 2.9 (95% confidence interval [CI] 1.6-5.2) increased odds of death, and a low platelet count (< 150,000/uL) was associated with 2.0 (95% CI 1.2-3.3) increased odds of death. The C-statistic for the model was 0.80.
CONCLUSION: We found an independent association between abnormalities in the coagulation system and mortality in ED patients with suspected infection. These findings underscore the close interaction between inflammation and coagulation and provide evidence that these simple laboratory tests should be routinely considered during the early evaluation of the infected patient.
Christopher M Fischer; Kiichiro Yano; William C Aird; Nathan I Shapiro
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Publication Detail:
Type:  Journal Article     Date:  2010-06-12
Journal Detail:
Title:  The Journal of emergency medicine     Volume:  42     ISSN:  0736-4679     ISO Abbreviation:  J Emerg Med     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-02-13     Completed Date:  2012-04-12     Revised Date:  2014-07-30    
Medline Journal Info:
Nlm Unique ID:  8412174     Medline TA:  J Emerg Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  127-32     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 Elsevier Inc. All rights reserved.
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MeSH Terms
Aged, 80 and over
Blood Coagulation Tests* / methods
Emergency Service, Hospital / statistics & numerical data
Hospital Mortality*
Hospitals, University / statistics & numerical data
Hospitals, Urban / statistics & numerical data
Infection / blood,  mortality*
Middle Aged
Multiple Organ Failure / blood,  mortality*
Odds Ratio
Predictive Value of Tests
Prospective Studies

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