Antithrombin deficiency is associated with mortality and impaired organ function in septic pediatric patients: a retrospective study

PeerJ

article

Christian Niederwanger¹  Tobias Hell²  Sophie Hofer³  Christina Salvador⁴  Miriam Michel⁵  Bettina Schenk³  Benedikt Treml³  Mirjam Bachler⁶ 

[1] Department of Pediatrics, Pediatrics I, Intensive Care Unit, Medical University of Innsbruck;Department of Mathematics, Faculty of Mathematics, Computer Science and Physics, University of Innsbruck;Department of General and Surgical Critical Care Medicine, Medical University of Innsbruck;Department of Pediatrics, Pediatrics I, Haematology and Oncology, Medical University of Innsbruck;Department of Pediatrics, Pediatrics III, Cardiology, Medical University of Innsbruck;Department of Sports Medicine, Alpine Medicine and Health Tourism, UMIT - University for Health Sciences

关键词: Children;    Antithrombin;    Mortality;    Sepsis;    Organ failure;    C-reactive protein;    Threshold level;   

DOI  :  10.7717/peerj.5538

学科分类：社会科学、人文和艺术（综合）

来源: Inra

【 摘 要 】

BackgroundSepsis remains a major problem in intensive care medicine. It is often accompanied by coagulopathies, leading to thrombotic occlusion of small vessels with subsequent organ damage and even fatal multi-organ failure. Prediction of the clinical course and outcome—especially in the heterogeneous group of pediatric patients—is difficult. Antithrombin, as an endogenous anticoagulant enzyme with anti-inflammatory properties, plays a central role in controling coagulation and infections. We investigated the relationship between antithrombin levels and organ failure as well as mortality in pediatric patients with sepsis.MethodsData from 164 patients under the age of 18, diagnosed with sepsis, were retrospectively reviewed. Antithrombin levels were recorded three days before to three days after peak C-reactive protein to correlate antithrombin levels with inflammatory activity. Using the concept of developmental haemostasis, patients were divided into groups <1 yr and ≥1 yr of age.ResultsIn both age groups, survivors had significantly higher levels of antithrombin than did deceased patients. An optimal threshold level for antithrombin was calculated by ROC analysis for survival: 41.5% (<1 yr) and 67.5% (≥1 yr). The mortality rate above this level was 3.3% (<1 yr) and 9.5% (≥1 yr), and below this level 41.7% (<1 yr) and 32.2% (≥1 yr); OR 18.8 (1.74 to 1005.02), p = 0.0047, and OR 4.46 (1.54 to 14.89), p = 0.003. In children <1 yr with antithrombin levels <41.5% the rate of respiratory failure (66.7%) was significantly higher than in patients with antithrombin levels above this threshold level (23.3%), OR 6.23 (1.23 to 37.81), p = 0.0132. In children ≥1 yr, both liver failure (20.3% vs 1.6%, OR 15.55 (2.16 to 685.01), p = 0.0008) and a dysfunctional intestinal tract (16.9% vs 4.8%, OR 4.04 (0.97 to 24.08), p = 0.0395) occurred more frequently above the antithrombin threshold level of 67.5%.ConclusionIn pediatric septic patients, significantly increased mortality and levels of organ failure were found below an age-dependent antithrombin threshold level. Antithrombin could be useful as a prognostic marker for survival and occurrence of organ failure in pediatric sepsis.

【 授权许可】

CC BY