Value of Thrombomodulin as a Marker for Sepsis in Critically Ill Children
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ORIGINAL ARTICLE
Value of Thrombomodulin as a Marker for Sepsis in Critically Ill Children Ahmed Anwar Khattab 1 & Ashraf Abd El Raouf Dawood 2 & Nagwan Yossery Saleh 1 Received: 6 April 2020 / Accepted: 1 November 2020 # Dr. K C Chaudhuri Foundation 2020
Abstract Objective Pediatric sepsis is altered organ function in critically ill children and a main etiology of mortality for children. Therefore, the authors aimed to assess the role of serum thrombomodulin as valuable biomarker in the diagnosis and prognosis of sepsis in acutely ill pediatrics in the intensive unit. Methods This prospective clinical study conducted on 140 acutely ill patients admitted to the Pediatric Intensive Care Unit (PICU) of Menoufia University Hospital and 50 apparently healthy controls from October 2018 through September 2019. All included children were subjected to clinical examination and the Pediatric Risk of Mortality (PRISM) and Pediatric Index of Mortality II (PIM II) scores were calculated. Serum thrombomodulin was measured for both patients and the control group upon admission. The children were followed for a period of 30 d. Results Serum thrombomodulin level was increased among all the patients and those with systemic inflammatory response syndrome (SIRS), sepsis and severe sepsis compared with controls (p < 0.001). Furthermore, serum thrombomodulin was higher in patients who died than who survived (p = 0.005). Thrombomodulin had area under Receiver Operating Characteristic Curve (AUC) =0.915 for predicting sepsis, whereas C-reactive protein had AUC = 0.789. According to the prognosis, thrombomodulin had AUC = 0.711 for predicting mortality whereas PRISM and PIM scores had AUC = (0.918, 0.960) respectively. Conclusions Serum thrombomodulin is a promising marker for pediatric sepsis. The data showed that serum thrombomodulin had a valuable role in diagnosis of sepsis early in critically ill pediatrics. Keywords Critically-ill . Pediatric . Sepsis . Thrombomodulin
Introduction Sepsis represents dysfunction of the organs which is caused by disturbing the host’s response to infection. Dysfunction of the organ can be defined as a change in organ function in critically-ill patients so that homeostasis can be maintained with early intervention [1]. In the United States, sepsis contributes more than one-third of children in tertiary care pediatric intensive care units who die having severe sepsis. In Egypt, infection accounts for 33%
* Nagwan Yossery Saleh [email protected] 1
Department of Pediatrics, Faculty of Medicine, Menoufia University Hospital, Menoufia Governorate, Shibin El Kom, Egypt
2
Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Menoufia University Hospital, Menoufia Governorate, Shibin El Kom, Egypt
of deaths under 5 y of age [2]. Increasing prevalence of sepsis in pediatrics in recent researches, may reflect increase in vulnerable children with chronic diseases, rising multidrugresistant organisms rate and opportunistic infections, and increase in sepsis control [3]. Endothelial
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