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. 2018 Nov 16;8(1):111.
doi: 10.1186/s13613-018-0457-8.

Inflammatory and coagulatory parameters linked to survival in critically ill children with sepsis

Christian Niederwanger  1 , Mirjam Bachler  2 , Tobias Hell  3 , Caroline Linhart  4 , Andreas Entenmann  1 , Agnes Balog  1 , Katharina Auer  5 , Petra Innerhofer  6
Affiliations

Inflammatory and coagulatory parameters linked to survival in critically ill children with sepsis

Christian Niederwanger et al. Ann Intensive Care. .

Abstract

Background: Sepsis is associated with a deflection of inflammatory and coagulative parameters, since some clotting factors are known to be involved in the host's defense against infection and inflammation. These parameters could play a crucial role in the course of sepsis and be used as prognostic markers in critically ill children.

Methods: A total of 250 critically ill pediatric patients diagnosed with sepsis were retrospectively analyzed to identify routinely measured predictors for in-hospital mortality at the peak level of C-reactive protein. Those parameters entered multivariate logistic regression analysis as well as a decision tree for survival.

Results: Multivariate logistic regression analysis revealed fibrinogen, platelets and activated partial thromboplastin time (aPTT) at the peak level of C-reactive protein to be predictors for survival (p = 0.03, p = 0.01 and p = 0.02, respectively). An increase in fibrinogen and platelets is linked to survival, whereas an aPTT prolongation is associated with higher mortality; adjusted odds ratios (95% CI) for an increase of 100 mg/dl in fibrinogen are 1.35 (1.04-1.82) per 50 G/l platelets 1.94 (1.3-3.29) and 0.83 (0.69-0.96) for an aPTT prolongation of 10 s. Decision tree analysis shows that a fibrinogen level below 192 mg/dl (90.9% vs. 13% mortality) is most distinctive in non-survivors.

Conclusions: High levels of fibrinogen and platelets as well as a non-overshooting aPTT are associated with a higher survival rate in pediatric patients with diagnosed sepsis. In particular, hypofibrinogenemia is distinctive for a high mortality rate in septic critically ill children.

Keywords: Children; Coagulation; Fibrinogen; Inflammation; Platelets; Sepsis; Survival.

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Figures

Fig. 1
Fig. 1
Progression of C-reactive protein and measured coagulation parameters. Depicted are medians with 95% CIs of the measured parameters for survivors (blue) and non-survivors (red) from 3 days prior to (d-3 to d-1) until 3 days after (d1 to d3) C-reactive protein peaked (d0). Asterisks indicate significant differences between survivors and non-survivors at the respective time point; n1 is the number of available measurements for survivors and n2 for non-survivors
Fig. 2
Fig. 2
Progression of measured coagulation parameters. Depicted are medians with 95% CIs of the measured parameters for survivors (blue) and non-survivors (red) from 3 days prior to (d-3 to d-1) until 3 days after (d1 to d3) C-reactive protein peaked (d0). Asterisks indicate significant differences between survivors and non-survivors at the respective time point; n1 is the number of available measurements for survivors and n2 for non-survivors
Fig. 3
Fig. 3
Adjusted odds ratios (95% CI) for survival retrieved from logistic regression. For an odds ratio greater than 1, an increase in the parameter decreases the mortality risk
Fig. 4
Fig. 4
Decision tree for survival. The classification tree was fitted with univariate predictors at the peak of C-reactive protein and age
Fig. 5
Fig. 5
Survival by age-adjusted hypofibrinogenemia, normal fibrinogenemia and hyperfibrinogenemia. The classification is based on the age-adjusted norm value ranges
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