الفهرس 
SepsisOnly 14 pages are availabe for public view
 |  | from | 136 |  |  |
| | | from | 136 | | |
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%.