Age-related Differences in Outcome and Severity of DIC in Children with Septic Shock and Purpura

Abstract

SummaryWe studied the influence of age on mortality and severity of clotting abnormalities in 79 children (median age: 3.1 years) with meningococcal sepsis. Parameters of coagulation and fibrinolysis and plasma levels of cytokines were prospectively measured on admission. The mortality rate was 27%. The age of survivors was significantly different from that of non-survivors (p = 0.013). With the exception of FVII, vWF and t-PA, parameters of coagulation and fibrinolysis, as well as plasma cytokine levels were related to outcome. Patients were divided in two groups: younger and older than median age. The mortality in children ≤3.1 years was 40% versus 13% in children >3.1 years (p = 0.006). In contrast to cytokine levels, which were not different between the two age groups, fibrinogen, prothrombin, factors V, VII, VIII, vWF, protein C, antithrombin, FDP, and the ratio PAI-l/t-PA were related to age, indicating a more severe coagulopathy in children ≤ 3.1 years despite a similar degree of inflammatory response. A relative deficiency of coagulation factors due to an immature state of the clotting system, as well as an inadequate fibrinolytic response, both related to age may have caused this more severe coagulative response in younger children, and may have contributed to the higher mortality rate.

Interaction ofNeisseria meningitidiswith Human Dendritic Cells

“…The production of cytokines resembling the one observed in our studies can be expected for brain DCs or blood-brain barrier DCs, and the entry of an enormous number of monocytes into the subarachnoid space is a hallmark of neisserial meningitidis (28). While the clinical symptoms of meningitis and septicemia are not mutually exclusive and often overlap, studies of the levels of cytokines, collected simultaneously from blood and CSF, suggest separate compartmentalized intravascular and intracranial inflammatory responses to infection (4,19,50,59,60).…”

Meningococcemia in Adults: A Review of the Literature

“…The form of meningococcemia associated with skin rashes and adrenal hemorrhage is known as Waterhouse-Friderichsen syndrome (46). Adrenal hemorrhage is a manifestation of fulminant meningococcemia, which also causes thrombotic lesions in the skin, kidneys, choroid plexus, lungs, and extremities (47,48). Meningococci are sometimes observed in biopsy samples of the dermis, which can be cultured for up to 12 hours after the initiation of antibiotic therapy (49)(50)(51).…”

Update on Meningococcal Disease with Emphasis on Pathogenesis and Clinical Management

“…In meningococcal infections, severe DIC is associated with a very poor prognosis (211,507). Østerud and Flaegstad showed that an increased activity of TF on monocytes is associated with a high fatality rate (341).…”