Antithrombin-III as an early prognostic factor in children with acute lung injury.
10.3345/kjp.2007.50.5.443
- Author:
Young Seung LEE
1
;
Seonguk KIM
;
Eun Kyeong KANG
;
June Dong PARK
Author Information
1. Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea. jdparkmd@snu.ac.kr
- Publication Type:Original Article
- Keywords:
Acute lung injury;
Mortality;
Prognostic factor;
Antithrombin-III
- MeSH:
Acute Lung Injury*;
Child*;
Consensus;
Hemodynamics;
Humans;
Hydrogen-Ion Concentration;
Hypertension;
Intensive Care Units;
Logistic Models;
Lung Compliance;
Lung Injury;
Mortality;
Odds Ratio;
Oxygen;
Survivors
- From:Korean Journal of Pediatrics
2007;50(5):443-448
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: To evaluate the potential prognostic value of the antithrombin-III (AT-III) level in the children with acute lung injury (ALI), we analyzed several early predictive factors of death including AT-III level at the onset of ALI and compared the relative risk of them for mortality. METHODS: Over a 18-month period, a total of 198 children were admitted to our pediatric intensive care unit and 21 mechanically ventilated patients met ALI criteria, as defined by American-European consensus conference, i.e., bilateral pulmonary infiltrates and PaO2/FiO2 lower than 300 without left atrial hypertension. Demographic variables, hemodynamic and respiratory parameters, underlying diseases, as well as Pediatric Risk of Mortality-III (PRISM-III) scores and Lung Injury Score (LIS) at admission were collected. AT-III levels were measured within 3 hours after admission. These variables were compared between survivors and non-survivors and entered into a multiple logistic regression analysis to evaluate their independent prognostic roles. RESULTS: The overall mortality rate was 38.1% (8/21). Non-survivors showed lower age, lower lung compliance, higher PEEP, higher oxygenation index (OI), lower arterial pH, lower PaO2/FiO2, higher PRISM-III score and LIS, and lower AT-III level. PRISM-III score, LIS, OI and decreased AT-III level (less than 70%) were independently associated with a risk of death and the odds ratio of decreased AT-III level for mortality is 2.75 (95% confidence interval; 1.28-4.12) CONCLUSION: These results suggest that the decreased level of AT-III is an important prognostic factor in children with ALI and the replacement of AT-III may be considered as an early therapeutic trial.
