Inflammatory and coagulatory parameters linked to survival in critically ill children with sepsis

Annals of Intensive Care

Petra Innerhofer¹  Katharina Auer²  Tobias Hell³  Caroline Linhart⁴  Andreas Entenmann⁵  Agnes Balog⁵  Christian Niederwanger⁵  Mirjam Bachler⁶ 

[1] Department of Anaesthesiology and Critical Care Medicine, Medical University of Innsbruck;Department of General and Surgical Critical Care Medicine, Medical University of Innsbruck;Department of Mathematics, Faculty of Mathematics, Computer Science and Physics, University of Innsbruck;Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck;Department of Pediatrics, Pediatrics I, Medical University of Innsbruck;Institute for Sports Medicine, Alpine Medicine and Health Tourism, UMIT - University for Health Sciences, Medical Informatics and Technology;

关键词: Fibrinogen;    Sepsis;    Children;    Survival;    Inflammation;    Coagulation;   

DOI  :  10.1186/s13613-018-0457-8

来源: DOAJ

【 摘 要 】

Abstract Background Sepsis is associated with a deflection of inflammatory and coagulative parameters, since some clotting factors are known to be involved in the host’s defense against infection and inflammation. These parameters could play a crucial role in the course of sepsis and be used as prognostic markers in critically ill children. Methods A total of 250 critically ill pediatric patients diagnosed with sepsis were retrospectively analyzed to identify routinely measured predictors for in-hospital mortality at the peak level of C-reactive protein. Those parameters entered multivariate logistic regression analysis as well as a decision tree for survival. Results Multivariate logistic regression analysis revealed fibrinogen, platelets and activated partial thromboplastin time (aPTT) at the peak level of C-reactive protein to be predictors for survival (p = 0.03, p = 0.01 and p = 0.02, respectively). An increase in fibrinogen and platelets is linked to survival, whereas an aPTT prolongation is associated with higher mortality; adjusted odds ratios (95% CI) for an increase of 100 mg/dl in fibrinogen are 1.35 (1.04–1.82) per 50 G/l platelets 1.94 (1.3–3.29) and 0.83 (0.69–0.96) for an aPTT prolongation of 10 s. Decision tree analysis shows that a fibrinogen level below 192 mg/dl (90.9% vs. 13% mortality) is most distinctive in non-survivors. Conclusions High levels of fibrinogen and platelets as well as a non-overshooting aPTT are associated with a higher survival rate in pediatric patients with diagnosed sepsis. In particular, hypofibrinogenemia is distinctive for a high mortality rate in septic critically ill children.

【 授权许可】

Unknown