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Cited by 34Sepsis Diagnosis and TreatmentInflammation biomarkers and pathwaysAcute Kidney Injury Research

The DOI matches its Crossref record; 55 of the 55 references it cites were found in a registry or an index.

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

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Niederwanger, Christian, Bachler, Mirjam, Hell, Tobias, Linhart, Caroline, Entenmann, Andreas, Balog, Agnes, Auer, Katharina, Innerhofer, Petra·2018·Annals of Intensive Care
DOI 10.1186/s13613-018-0457-8PMC PMC6240023
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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.

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Crossref · 10.1186/s13613-018-0457-8

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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. 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-survivorsCC BY · PubMed Central
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. 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-survivorsCC BY · PubMed Central
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. 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 riskCC BY · PubMed Central
Fig. 4 Decision tree for survival. The classification tree was fitted with univariate predictors at the peak of C-reactive protein and age
Fig. 4 Decision tree for survival. The classification tree was fitted with univariate predictors at the peak of C-reactive protein and ageCC BY · PubMed Central
Fig. 5 Survival by age-adjusted hypofibrinogenemia, normal fibrinogenemia and hyperfibrinogenemia. The classification is based on the age-adjusted norm value ranges
Fig. 5 Survival by age-adjusted hypofibrinogenemia, normal fibrinogenemia and hyperfibrinogenemia. The classification is based on the age-adjusted norm value rangesCC BY · PubMed Central

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Metadata

Authors
Niederwanger, C., Bachler, M., Hell, T., Linhart, C., Entenmann, A., Balog, A., Auer, K., & Innerhofer, P.
Affiliations
  • Innsbruck Medical University (AT)
  • UMIT TIROL - Private University for Health Sciences and Health Technology (AT)
  • Universität Innsbruck (AT)
Corresponding author
Bachler, Mirjam
ORCID
Venue
Annals of Intensive Care
Publisher
Elsevier BV
Published
2018
Volume
8
Issue
1
Pages
111
ISSN
2110-5820 (ISSN-L)
DOI
10.1186/s13613-018-0457-8
PMC
PMC6240023
OpenAlex
W2901510340
Cited by
34
References
54
Citations by year
2026: 4 · 2025: 5 · 2024: 6 · 2023: 6 · 2022: 2 · 2021: 7 · 2020: 4
FWCI
2.15
Type
journal article
Language
en
Open access
Licence
Locations
  • Annals of Intensive Care (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, other-oa)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Sepsis Diagnosis and Treatment
  • Life Sciences › Immunology and Microbiology › Immunology › Inflammation biomarkers and pathways
  • Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
Keywords
pediatric sepsis, critically ill children, in-hospital mortality, prognostic factors, fibrinogen, platelets, activated partial thromboplastin time, C-reactive protein, hypofibrinogenemia, coagulation, inflammation, survival prediction

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