الفهرس | Only 14 pages are availabe for public view |
Abstract Sepsis is a life-threatening condition which affects many children regardless of some underlying healthcare issues. Sepsis is said to be one of the leading causes of death among children even in advanced countries. Although demographic data does not clearly show it, many children who are reported to die from other underlying conditions actually die directly from sepsis. 70% of the 8 million deaths of children under 5 years in developing countries was due to infectious diseases that mostly ended with sepsis. The incidence of sepsis worldwide reached 0.56 per 1,000 children and 5.6 per 1,000 babies with the presentation of deaths by 10.6 %. ADAMTS-13 is the plasma metalloprotease responsible for regulating the multimeric structure of VWF. The level of (ultra large) VWF multimers in patients with sepsis was inversely correlated with the plasma level of ADAMTS-13. The association between low ADAMTS-13 levels and sepsis severity was confirmed. Hypothetically, the inflammation- mediated massive release of VWF from the endothelium consumes and depletes the available level of ADAMTS- 13, leading to insufficient cleavage capacity and control of VWF multimeric size. The current study aimed to evaluate serum ADAMTS-13 level in children with sepsis and its possible relation to prognosis. The study was conducted on 70 children admitted to Pediatric Intensive Care Unit (PICU) at Menoufia University Hospital. Summary 96 Children included in this study were divided into two groups as follow: group I: Consist of 70 cohort of critically ill children admitted into the PICU with a diagnosis of sepsis. group II: Consist of 18 healthy children of comparable age and sex. All patients were selected according to the inclusion and exclusion criteria: Inclusion criteria: Any patient from the age of 1 month to 16 years admitted into the PICU with sepsis will be included in the study. Exclusion criteria: Patients younger than 1 month or older than 16 years of age, failure to withdraw a blood sample for ADAMTS-13 measurement within 24 hours of PICU admission and lack of parental consent. For every patient the following was done: Full history taking, Examination and Laboratory investigations including: CBC, CRP, liver function test, kidney function tests, ABG, and blood culture and measurement of serum ADAMTS-13 level to patients within 24 hours of PICU admission as well as to controls. Serum ADAMTS-13 level will then be compared between patients and controls. Results of the current study can be summarized as follows: There was highly statistically significant difference among patient and control groups regarding ADAMTS-13 level. That ADAMTS- 13 was significantly lower among patients compared with controls. ADAMTS-13 was significantly lower among both patients with severe sepsis and those with septic shock compared with patients with sepsis. No significant difference was found between severe sepsis and septic shock. ADAMTS-13 was significantly lower among patients Summary 97 with ARDS, mechanical ventilation, vasoactive medications, and MODS (day 1 and day3). There is significant difference between sepsis and severe sepsis regarding PIM2, SOFA, and vasoactive infusion days. While, there is no significant difference between sepsis and severe sepsis regarding the other clinical or demographic variables. There is significant difference between sepsis and septic shock regarding PIM2, SOFA, and vasoactive infusion days, ventilatorfree days, and vasopressor-inotrope score (day1 and 2). There is significant difference between severe sepsis and septic shock regarding ventilator-free days and vasopressor-inotrope score (day1 and 2). Non - Survivors had significantly higher frequency of mortality, septic shock, MODS (day 1 and 3), mechanical ventilation, nosocomial infections, vasoactive medication use, and ARDS compared with survivors. Non-survivors also had higher PIM2 score, vasoactive infusion days, and vasopressor-inotrope score (day 1 and 2) but lower ventilator-free days. ADAMTS-13, pSOFA, PIM2, and platelets were independent predictors of mortality. There was a significant negative correlation. The correlation is negative because the sign of the correlation coefficient (rs) is minus between ADAMTS-13 and each of vasopressor. Inotrope score (D1 and D2), vasoactive infusion days and PSOFA (P<0.001). ADAMTS-13 showed excellent performance in discriminating septic patients from controls. At a cutoff level of ≤ 4.4 pg/ml, ADAMTS-13 had a sensitivity of 97.1% and a specificity of 100%. |