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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

Open access
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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Figures

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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