| Antithrombin-III as an early prognostic factor in
children with acute lung injury |
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Young Seung Lee, Seonguk Kim, Eun Kyeong Kang, June Dong Park |
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Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea |
| 급성 폐손상 소아 환자에서 조기 예후 인자로서의 antithrombin-III |
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이영승, 김성국, 강은경, 박준동 |
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서울대학교 의과대학 소아과학교실 |
Correspondence:
June Dong Park, Email: jdparkmd@snu.ac.kr
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| 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. |
| Key Words:
Acute lung injury, Mortality, Prognostic factor, Antithrombin-III |
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