J Korean Med Sci.  2012 Dec;27(12):1541-1546. 10.3346/jkms.2012.27.12.1541.

Coagulopathy as a Prognostic Factor of Acute Lung Injury in Children

• Han YJ
• Park JD
• Choi JW
• Suh DI
• Koh YY

• KMID: 2157979
• DOI: http://doi.org/10.3346/jkms.2012.27.12.1541

Abstract

The coagulation cascade and inflammatory process are known to be associated with the pathophysiology of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). We retrospectively investigated laboratory values indicating coagulopathy obtained within 24 hr from diagnosis of ALI/ARDS in 79 children who received mechanical ventilation between 2008 and 2009 and their final outcomes. Prothrombin time (PT) (P = 0.001) and activated partial thromboplastin time PTT (APTT) (P = 0.001) were more prolonged in non-survivors than survivors (mean; 1.57 vs 1.33; 63 vs 57). In multivariate analysis with stratification by oxygenation-index (< 14.5, > or = 14.5), prolonged PT (> or = 1.46 international normalized ratio, [INR]) (hazard ratio; 2.043, 1.027-4.064) was associated with lower non-pulmonary-organ-failure-free survival rate (FFS), and prolonged APTT (> or = 50 seconds) (2.062, 1.031-4.121; 2.422, 1.227-4.781) was associated with lower overall survival rate (OS) and lower FFS. In stratification by ventilation-index (< 40, > or = 40), prolonged PT (2.232, 1.095-4.540; 2.177, 1.092-4.342) and prolonged APTT (2.574, 1.230-5.386; 3.089, 1.500-6.360) were associated with lower OS and lower FFS. Prolonged PT and APTT are associated with mortality in mechanically ventilated children with ALI/ARDS. We suggest PT and APTT as prognostic factors of ALI/ARDS in children.

Keyword

Acute Lung Injury; Acute Respiratory Distress Syndrome; Coagulopathy; Prothrombin Time; Partial Thromboplastin Time; Prognosis

MeSH Terms

Acute Lung Injury/*etiology/mortality
Adolescent
Blood Coagulation Disorders/*complications
Child
Child, Preschool
Female
Humans
Infant
Infant, Newborn
Male
Multivariate Analysis
Partial Thromboplastin Time
Prognosis
Prothrombin Time
Respiratory Distress Syndrome, Adult/*etiology/mortality
Retrospective Studies
Survival Rate
Young Adult

Figure

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  Fig. 1 The overall survival and non-pulmonary-organ-failure-free survival rate analyzed by Kaplan-Meier method.

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