Antithrombin-III as an early prognostic factor in children with acute lung injury

Lee, Young Seung; Kim, Seonguk; Kang, Eun Kyeong; Park, June Dong

doi:10.3345/kjp.2007.50.5.443

Cited by 4 publications

(4 citation statements)

References 21 publications

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“…McClintock et al analyzed 50 adults with ALI and reported that plasma protein C levels were lower in non-survivors than in survivors (6). Researches about pediatric patients with ALI/ARDS have been rarely performed though our center previously reported that decreased antithrombin III levels were associated with the risk of death in children with ALI/ARDS (12). …”

Section: Discussionmentioning

confidence: 99%

Coagulopathy as a Prognostic Factor of Acute Lung Injury in Children

et al. 2012

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The coagulation cascade and inflammatory process are known to be associated with the pathophysiology of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). We retrospectively investigated laboratory values indicating coagulopathy obtained within 24 hr from diagnosis of ALI/ARDS in 79 children who received mechanical ventilation between 2008 and 2009 and their final outcomes. Prothrombin time (PT) (P = 0.001) and activated partial thromboplastin time PTT (APTT) (P = 0.001) were more prolonged in non-survivors than survivors (mean; 1.57 vs 1.33; 63 vs 57). In multivariate analysis with stratification by oxygenation-index (< 14.5, ≥ 14.5), prolonged PT (≥ 1.46 international normalized ratio, [INR]) (hazard ratio; 2.043, 1.027-4.064) was associated with lower non-pulmonary-organ-failure-free survival rate (FFS), and prolonged APTT (≥ 50 seconds) (2.062, 1.031-4.121; 2.422, 1.227-4.781) was associated with lower overall survival rate (OS) and lower FFS. In stratification by ventilation-index (< 40, ≥ 40), prolonged PT (2.232, 1.095-4.540; 2.177, 1.092-4.342) and prolonged APTT (2.574, 1.230-5.386; 3.089, 1.500-6.360) were associated with lower OS and lower FFS. Prolonged PT and APTT are associated with mortality in mechanically ventilated children with ALI/ARDS. We suggest PT and APTT as prognostic factors of ALI/ARDS in children.

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Section: Discussionmentioning

confidence: 99%

Coagulopathy as a Prognostic Factor of Acute Lung Injury in Children

et al. 2012

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“…Antithrombin-III, a serine protease inhibitor, inhibits coagulation factors associated with the intrinsic pathway (Factors X, IX, XI, XII) and thrombin (Factor II). Decreased AT-III levels have been associated with increased mortality in PARDS (87). Protein C is a protein activated by the thrombin-thrombomodulin complex on endothelial cells.…”

Section: Biomarkers Of Dysregulated Coagulation and Fibrosismentioning

confidence: 99%

Biomarkers in pediatric acute respiratory distress syndrome

Carlton¹,

Flori²

2019

Ann. Transl. Med.

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Pediatric acute respiratory distress syndrome (PARDS) is a heterogenous process resulting in a severe acute lung injury. A single indicator does not exist for PARDS diagnosis. Rather, current diagnosis requires a combination of clinical and physiologic variables. Similarly, there is little ability to predict the path of disease, identify those at high risk of poor outcomes or target therapies specific to the underlying pathophysiology. Biomarkers, a measured indicator of a pathologic state or response to intervention, have been studied in PARDS due to their potential in diagnosis, prognostication and measurement of therapeutic response. Additionally, PARDS biomarkers show great promise in furthering our understanding of specific subgroups or endotypes in this highly variable disease, and thereby predict which patients may benefit and which may be harmed by PARDS specific therapies. In this chapter, we review the what, when, why and how of biomarkers in PARDS and discuss future directions in this quickly changing landscape.

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“…Decreased antithrombin III levels are also associated with mortality in pediatric ARDS. 38 Biomarkers of endothelial injury such as thrombomodulin, 39 von Willebrand factor, 40 angiopoietin 2, and soluble receptor for advance glycation end products 41 are also associated with increased mortality and decreased ventilatorfree days in pediatric ARDS. These biomarkers suggest that coagulopathy and endothelial injury are important pathophysiologic features, and they support a biologic plausibility for in situ pulmonary artery thrombosis in pediatric ARDS.…”

Section: In Situ Pulmonary Artery Thrombosismentioning

confidence: 99%

Pulmonary Thromboses in Pediatric Acute Respiratory Distress Syndrome

Caudron¹,

Holt²,

Cuvelier³

et al. 2018

Respir Care

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Pediatric ARDS continues to be a management challenge in the ICU with prolonged hospitalizations and high mortality. Thromboembolic pulmonary embolism and in situ pulmonary artery thrombosis might represent underappreciated thrombotic processes for a subset of these patients. Although well described in the adult literature, descriptions of pulmonary thromboses with pediatric ARDS are limited to case reports. However, many risk factors for pulmonary thromboses are present in children with ARDS (eg, coagulopathy, endothelial injury, central venous catheters, concomitant inflammatory diseases), suggesting a much higher incidence is plausible. Based on an interpretation of animal, pediatric, and adult data, we propose a diagnostic algorithm to facilitate a timely and accurate diagnosis. Observing an alveolar dead space fraction > 0.25, or either a 50% increase in physiologic dead space/tidal volume or a central venous saturation < 60% over 24 h, triggers the algorithm. Together with targeted heparin treatment and right ventricular afterload reduction, clinical outcomes might improve if this particular patient subgroup can be identified early. While anticoagulation is recommended in adults with confirmed pulmonary embolism and low early mortality risk, data for children are limited.

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Antithrombin-III as an early prognostic factor in children with acute lung injury

Cited by 4 publications

References 21 publications

Coagulopathy as a Prognostic Factor of Acute Lung Injury in Children

Coagulopathy as a Prognostic Factor of Acute Lung Injury in Children

Biomarkers in pediatric acute respiratory distress syndrome

Pulmonary Thromboses in Pediatric Acute Respiratory Distress Syndrome

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