Dataset Information

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

ABSTRACT:

Background

Sepsis 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.

Methods

Data 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.

Results

In 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%.

Conclusion

In 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.

SUBMITTER: Niederwanger C

PROVIDER: S-EPMC6129139 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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

Niederwanger Christian C Hell Tobias T Hofer Sophie S Salvador Christina C Michel Miriam M Schenk Bettina B Treml Benedikt B Bachler Mirjam M

PeerJ 20180905

<h4>Background</h4>Sepsis 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 infecti ...[more]

PMID: 30202654

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Dataset Information

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

Background

Methods

Results

Conclusion

Publications

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

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