Coagulopathy as a Prognostic Factor of Acute Lung Injury in Children

Abstract

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.

Treatment of Paraquat-Induced Lung Injury With an Anti-C5a Antibody: Potential Clinical Application*

“…4 , Supplemental Digital Content 6, http://links.lww.com/CCM/D164 ; legend, Supplemental Digital Content 1, http://links.lww.com/CCM/D159 ). Coagulation abnormality has been suggested as one of the prognostic factors for ALI/acute respiratory distress syndrome ( 32 , 33 ).…”

Application of coagulation parameters at the time of necrotizing enterocolitis diagnosis in surgical intervention and prognosis

“…Hence, adjunctive therapeutic strategies for coagulation impairment, including anticoagulants and restoration of physiological anticoagulant mechanisms, can help reduce the severity of inflammation and even improve the overall prognosis [ 31 ]. Coagulation parameters are the indirect reflection of coagulation status and have been reported clinically to make preliminarily judgements about condition and prognosis, so as to develop timely coping strategies [ 7 , 25 , 34 ].…”

Biomarkers in pediatric acute respiratory distress syndrome

“…Hyaline membranes, the characteristic pathology described in ARDS, are made of fibrin breakdown products and proteinaceous residua following alveolar epithelial cell injury. Indeed, abnormalities of the coagulation system are associated with morbidity and mortality in ARDS (83)(84)(85)(86). Many of these are available as part of routine clinical practice.…”