The Association between the Level of Antithrombin III and Mortality in Children with Sepsis

Indah Nur Lestari; Chairul Yoel; Munar Lubis

doi:10.3889/oamjms.2019.211

Authors

Indah Nur Lestari Department of Child Health, Medical School, University of Sumatera Utara, Medan, Indonesia
Chairul Yoel Department of Child Health, Medical School, University of Sumatera Utara, Medan, Indonesia
Munar Lubis Department of Child Health, Medical School, University of Sumatera Utara, Medan, Indonesia

DOI:

https://doi.org/10.3889/oamjms.2019.211

Keywords:

Sepsis, Children, Antithrombin III, Mortality

Abstract

BACKGROUND: Sepsis is a significant cause of morbidity and mortality in children. The diagnosis of sepsis remains continuing to develop which determines treatment and prognostic. Antithrombin III is one of the coagulation markers to evaluate the prognosis of sepsis.

AIM: To determine the association between the level of antithrombin III and mortality in children with sepsis in the Pediatric Intensive Care Unit, Haji Adam Malik General Hospital, Medan.

METHODS: A cross-sectional study was conducted in Haji Adam Malik General Hospital, Medan from April until June 2015. There were 41 children with sepsis. Sepsis was diagnosed from clinical and laboratory findings. Complete blood count, antithrombin III level, C-reactive protein and procalcitonin were an indicator of unproven sepsis that performed in the laboratory. Meanwhile blood culture was performed in the microbiology laboratory. The association between the level of antithrombin III and mortality was analysed by using chi-square test.

RESULTS: Of the 41 participants, the low antithrombin III level was 13 of 41 children (31.7%) meanwhile the normal antithrombin III level was 28 of 41 children (68.3%). There was 8 of 13 (42.1%) and 11 of 28 (57.9%) children in death cases of low and normal antithrombin III level, respectively. Samples with low antithrombin III level had 2.473 higher risk mortality than normal antithrombin III level (P = 0.184; 95% CI 0.641 to 9.5421; PR = 2.473).

CONCLUSION: There was no statistically significant association between levels of antithrombin III and mortality in children with sepsis.

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References

Goldstein B, Giroir B, Randolph A. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in paediatrics. Pediatric critical care medicine. 2005; 6(1):2-8. https://doi.org/10.1097/01.PCC.0000149131.72248.E6 PMid:15636651

Carvalho PRA, Trotta EA. Advances in sepsis diagnosis and treatment. Curr Opin in Pediatr. 2003; 79:95-204.

Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Pediatr Crit Care Med. 2013; 41(2):580-637. https://doi.org/10.1097/CCM.0b013e31827e83af PMid:23353941

Goldstein B, Giroir B, Randolph A. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med. 2005; 6(1):2-4. https://doi.org/10.1097/01.PCC.0000149131.72248.E6 PMid:15636651

Melendez E, Bachur R. Advances in emergency management of pediatric sepsis. Curr Opin in Pediatr. 2006; 18:245-53. https://doi.org/10.1097/01.mop.0000193305.55635.ff PMid:16721143

Carcillo JA, Planquois JM, Golstein B. Early markers of infection and sepsis in newborn and children. Advances in Sepsis. 2006; 5(4):118-25.

Ersoy B, Nehir H, Altinoz S, Yilmaz O, Dundar PE, Aydogan A. Prognostic value of initial antithrombin levels in neonatal sepsis. Indian Pediatr. 2007; 44:581-4. PMid:17827633

Wiedermann CJ. Clinical review: molecular mechanisms underlying the role of antithrombin in sepsis. Crit Care. 2006; 10(209):1-9.

Kementrian Kesehatan Republik Indonesia. Riset Kesehatan Dasar 2007. Departemen Kesehatan Republik Indonesia. 2007:1-4.

Ng PC. Diagnostic markers of infection in neonates. Arch Dis Child Fetal Neonatal. 2004; 89:229-35. https://doi.org/10.1136/adc.2002.023838 PMCid:PMC1721679

Lauterbach R, Pawlik D, Radziszewska R, Wozniak J, Rytlewski K. Plasma antithrombin III and protein C levels in early recognition of late-onset sepsis in newborns. Eur J Pediatr. 2006; 165:585-9. https://doi.org/10.1007/s00431-006-0139-7 PMid:16636814

Choi Q, Ki Ho Hong, Ji-Eun Kim, Hyun Kyung kim. Changes in plasma levels of natural anticoagulants in disseminated intravascular coagulation: High prognostic value of antithrombin and protein C in patients with underlying sepsis or severe infection. Ann Lab Med. 2014; 34:85-91. https://doi.org/10.3343/alm.2014.34.2.85 PMid:24624342 PMCid:PMC3948838

Larosa S, Steven O, Barbara U, Sau CBY, Jefffrey H, Andrew J,dkk. Decresed protein C, protein S and antithrombin levels are predictive of poor outcome in gram-negative sepsis caused by Burkholderia pseudomallei. Infect Dis. 2006; 10:25-31.