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Meta-Analysis
. 2007 Mar;8(2):96-101.
doi: 10.1097/01.PCC.0000257097.42640.6F.

Early elevation of plasma von Willebrand factor antigen in pediatric acute lung injury is associated with an increased risk of death and prolonged mechanical ventilation

Heidi R Flori  1 , Lorraine B Ware, Meredith Milet, Michael A Matthay
Affiliations
Meta-Analysis

Early elevation of plasma von Willebrand factor antigen in pediatric acute lung injury is associated with an increased risk of death and prolonged mechanical ventilation

Heidi R Flori et al. Pediatr Crit Care Med. 2007 Mar.

Abstract

Objective: Von Willebrand factor antigen (vWF-Ag) is a marker of pulmonary and systemic endothelial activation and injury. Adult studies indicate that patients with plasma vWF-Ag levels > or = 450% of control early in the course of acute lung injury (ALI) have an increased risk of death. The objective of this study was to evaluate whether vWF-Ag is elevated in the early phase of ALI in children and whether the magnitude of the increase was predictive of two important outcomes: mortality or duration of mechanical ventilation.

Design: Two-center, prospective observational study.

Setting: Two pediatric intensive care units: one in an academic university setting and one in a major community children's hospital.

Patients: After appropriate consent, plasma was collected from 48 pediatric patients on day 1 of ALI, 45 patients on day 2 of ALI, and four intubated controls.

Interventions: None.

Measurements and main results: Mean PaO2/FiO2 at the onset of ALI was 140 +/- 70, and mortality rate was 17%. vWF-Ag levels on day 1 of ALI were higher in patients compared with controls (287 +/- 183 vs. 87 +/- 84% of control [mean +/- SD], p < .05). Patients with vWF-Ag levels > or = 450% of control on day 1 of ALI had a markedly greater risk of death (odds ratio, 7.0; confidence interval, 1.31, 37.30; p < .05). Multivariate analysis revealed that elevated vWF-Ag level and either presence of multiple organ system failure or Pediatric Risk of Mortality III score independently predict increased risk of death. vWF-Ag levels on day 2 of ALI were significantly higher in patients who required prolonged mechanical ventilation (316 +/- 173 vs. 191 +/- 89% of control, p < .05).

Conclusions: Early injury to the systemic and pulmonary endothelium, as measured by plasma vWF-Ag levels, is associated with an increased risk of death and prolonged mechanical ventilation in pediatric patients with ALI.

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Conflict of interest statement

The authors have not disclosed any potential conflicts of interest.

Figures

Figure 1
Figure 1
Plasma von Willebrand factor antigen (VWF-Ag) levels in acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) patients (n = 48) vs. intubated controls (n = 4). Mean plasma VWF-Ag levels were higher in ALI/ARDS patients compared with controls (*p = .03, Student's t-test). Data presented as mean ± sd.
Figure 2
Figure 2
Categorized plasma von Willebrand factor antigen (VWF-Ag) levels on day 1 of acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) and mortality. Eight patients had plasma VWF-Ag levels ≥450% of control and 40 patients had plasma VWF-Ag levels <450% of control (*p = .03, Fisher's exact statistic).
Figure 3
Figure 3
Categorized plasma von Willebrand factor antigen (VWF-Ag) levels on day 2 of acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) and need for prolonged mechanical ventilation (<15 ventilator-free days per 28-day month). Five patients had plasma VWF-Ag levels ≥450% of control and 40 patients had plasma VWF-Ag levels <450% of control (*p = .02, Fisher's exact statistic).
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Comment in

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