All issues > Volume 50(5); 2007

Original Article

Korean J Pediatr. 2007;50(5):443-448. Published online May 15, 2007.

Antithrombin-III as an early prognostic factor in children with acute lung injury

Young Seung YS Lee¹, Seonguk SG Kim¹, Eun Kyeong EK Kang¹, June Dong JD Park¹

¹Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea

Correspondence June Dong JD Park ,Email: jdparkmd@snu.ac.kr

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.

Keywords :Acute lung injury, Mortality, Prognostic factor, Antithrombin-III