Hemostasis in patients with influenza

Influenza remains the most significant acute respiratory viral infection due to its high incidence rate, potential for severe disease progression, and complications. Chronic cardiovascular diseases, which are associated with endothelial dysfunction, represent risk factors for severe influenza outcomes and poor prognosis. Given the important role of hemostatic disorders in the development of cardiovascular pathology during severe infectious diseases, studying hemostasis in influenza appears highly relevant.
Research Objective: To evaluate hemostatic parameters in adult patients with complicated and uncomplicated influenza.
Materials and Methods. We analyzed medical records of 64 influenza patients aged 19 to 90 years hospitalized at the Professor A.F. Agafonov Republican Clinical Infectious Diseases Hospital (GAUZ “RKIB”) between December 1, 2023, and March 1, 2024. The median patient age was 65 years. Influenza A was diagnosed in 61 patients (95%), predominantly caused by A/H1N1 (50 cases) and A/H3N2 (11 cases). Three patients (5%) had influenza B. Pneumonia, confirmed by chest CT, complicated influenza in 32 patients (50%). Chronic cardiovascular diseases were present in 45 patients (70%). Hemostasis was assessed through platelet count, Ddimer level, prothrombin time (PT), prothrombin index (PTI), INR, and aPTT.
Results. The acute phase of influenza was associated with elevated D-dimer levels, which were significantly higher than in the control group (p=0.000). The median D-dimer in influenza patients was 4.9 times higher than controls. Patients with pre-existing cardiovascular disease had 2.5-fold higher D-dimer levels compared to those without (p=0.02). Influenza patients with pneumonia showed 3.8-fold higher median D-dimer levels versus those without pneumonia (p=0.0009). Non-survivors had 2.8-fold higher admission D-dimer levels than survivors (p=0.003). A D-dimer level >3000 ng/mL in influenza-associated pneumonia correlated with high mortality risk (p<0.05).
Conclusion. Patients with influenza complicated by pneumonia exhibit elevated D-dimer levels, creating a prothrombotic state that predisposes to thrombotic complications.

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