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Mehdi Mirsaeidi, MD; Paula Peyrani, MD; Stefano Aliberti, MD; Giovanni Filardo, PhD; Jose Bordon, MD; Francesco Blasi, MD; Julio Ramirez, MD
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From the Infectious Diseases Division (Drs Mirsaeidi, Peyrani, and Ramirez) and the Department of Medicine (Dr Peyrani), Medical School, University of Louisville; IRCCS Fondazione Policlinico-Mangiagalli-Regina Elena, Dipartimento toraco-polmonare e cardio-circolatorio, The Institute of Respiratory Disease (Drs Aliberti and Blasi), University of Milan; The Institute for Health Care Research and Improvement (Dr Filardo), Baylor Research Institute; and the Section of Infectious Diseases, Department of Medicine (Dr Bordon), Providence Hospital.

Correspondence to: Julio Ramirez, MD, University of Louisville, Division of Infectious Diseases, 501 E Broadway MedCenter One, Ste 380,Louisville, KY 40202; e-mail: j.ramirez@louisville.edu


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;138(5):1279-1280. doi:10.1378/chest.10-1837
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To the Editor:

We agree with Georges and colleagues that in hospitalized patients requiring ICU admission for severe community-acquired pneumonia (CAP), the presence of severe thrombocytopenia should be considered a risk factor for mortality. A low platelet count is a marker of severe sepsis and may indicate the presence of disseminated intravascular coagulation. In our recent article, we also found that thrombocytopenia was associated with an increased risk of mortality.1

Even though we found that thrombocytosis was associated with poor outcomes, Georges and colleagues did not find this association in their population of CAP patients. The authors indicated that our finding of an association between elevated platelet count and poor outcomes “could be explained by the moderate severity of CAP” in the patients in our series, with only 17% of these patients requiring ICU admission. Based on this observation, we may speculate that a low platelet count, being a marker of severe sepsis, predicts poor outcomes in patients with CAP in the ICU. On the other hand, an elevated platelet count may predict poor outcomes in patients with CAP in the absence of severe sepsis. In these patients, platelet-induced thrombus formation may play a role in their clinical outcomes. Using the data they presented, Georges and colleagues stated that in patients with thrombocytosis cause of death was mostly related to complications of ICU stay or comorbidity. It is interesting that in these patients the majority of deaths were likely related to thrombus formation because patients died of cerebrovascular ischemia, mesenteric ischemia, or myocardial infarction. We published an association of acute myocardial infarction and poor outcomes in hospitalized patients with CAP.2 Because platelet-induced thrombus formation may be amenable to treatment, further research is necessary to determine if a causal association exists among CAP, elevated platelet count, thrombus formation, organ ischemia, and clinical outcomes.

Mirsaeidi M, Peyrani P, Aliberti S, et al. Thrombocytopenia and thrombocytosis at time of hospitalization predict mortality in patients with community-acquired pneumonia. Chest. 2010;1372:416-420. [CrossRef] [PubMed]
 
Ramirez J, Aliberti S, Mirsaeidi M, et al. Acute myocardial infarction in hospitalized patients with community-acquired pneumonia. Clin Infect Dis. 2008;472:182-187. [CrossRef] [PubMed]
 

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Mirsaeidi M, Peyrani P, Aliberti S, et al. Thrombocytopenia and thrombocytosis at time of hospitalization predict mortality in patients with community-acquired pneumonia. Chest. 2010;1372:416-420. [CrossRef] [PubMed]
 
Ramirez J, Aliberti S, Mirsaeidi M, et al. Acute myocardial infarction in hospitalized patients with community-acquired pneumonia. Clin Infect Dis. 2008;472:182-187. [CrossRef] [PubMed]
 
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