| Activation of the coagulation cascade in patients with leptospirosis. | |
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MedLine Citation:
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PMID: 18171258 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Disseminated intravascular coagulation (DIC) is common among patients with sepsis. Leptospirosis is an important cause of sepsis in tropical areas, and pulmonary hemorrhage associated with thrombocytopenia is the major cause of death, but the coagulopathy in severe leptospirosis has not been further characterized. The aim of this study was to evaluate coagulation factors and the presence of DIC in patients with leptospirosis in northeast Thailand. METHODS: We measured plasma concentrations of fibrinogen, D-dimer, thrombin-antithrombin III complexes, and prothrombin fragment 1,2 and evaluated the DIC score in 79 patients with culture-confirmed and/or serologically confirmed leptospirosis and in 33 healthy Thai control subjects. RESULTS: The median concentrations of fibrinogen, D-dimer, thrombin-antithrombin III complexes, and prothrombin fragment 1,2 were significantly elevated in a cohort of 79 patients with leptospirosis, compared with healthy control subjects (P<or=.001 for all tests). Patients with leptospirosis had significantly longer prothrombin times, longer activated partial thromboplastin times, and lower platelet counts. Thrombocytopenia was present in 38% of case patients and occurred more frequently among patients with culture-negative leptospirosis; in multivariate analysis, it was the only hemostasis factor independently associated with clinical bleeding. Patients who were culture-negative for Leptospira species had higher Acute Physiology and Chronic Health Evaluation II and Sepsis-Related Organ Failure Assessment scores and more bleeding complications. Nearly one-half of patients with leptospirosis had overt DIC as defined by an International Society on Thrombosis and Hemostasis DIC score. CONCLUSIONS: Activation of the coagulation system is an important feature of leptospirosis. Thrombocytopenia is an indicator of severe disease and risk of bleeding. |
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Authors:
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Wirongrong Chierakul; Panatsaya Tientadakul; Yupin Suputtamongkol; Vanaporn Wuthiekanun; Kriangsak Phimda; Roongrueng Limpaiboon; Nisarat Opartkiattikul; Nicholas J White; Sharon J Peacock; Nicholas P Day |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America Volume: 46 ISSN: 1537-6591 ISO Abbreviation: Clin. Infect. Dis. Publication Date: 2008 Jan |
Date Detail:
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Created Date: 2008-01-03 Completed Date: 2008-02-26 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9203213 Medline TA: Clin Infect Dis Country: United States |
Other Details:
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Languages: eng Pagination: 254-60 Citation Subset: IM |
Affiliation:
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Department of Clinical Tropical Medicine, Mahidol University, Bangkok, Thailand. tmwcr@mahidol.ac.th |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Aged Animals Antithrombin III Blood Coagulation / physiology* Disseminated Intravascular Coagulation / blood* Female Fibrin Fibrinogen Degradation Products Fibrinogen Humans Leptospira / isolation & purification* Leptospirosis / blood*, microbiology Male Middle Aged Peptide Fragments / blood Peptide Hydrolases / blood Platelet Count / methods Prospective Studies Prothrombin Prothrombin Time / methods Sepsis / blood, microbiology Thrombocytopenia / blood |
| Grant Support | |
ID/Acronym/Agency:
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//Wellcome Trust |
| Chemical | |
Reg. No./Substance:
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0/Fibrin Fibrinogen Degradation Products; 0/Peptide Fragments; 0/antithrombin III-protease complex; 0/fibrin fragment D; 0/prothrombin fragment 1.2; 9000-94-6/Antithrombin III; 9001-26-7/Prothrombin; 9001-32-5/Fibrinogen; EC 3.4.-/Peptide Hydrolases |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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