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Biomarkers of disseminated intravascular coagulation in pediatric intensive care unit in Thailand
Author(s) -
Padungmaneesub Wiralpat,
Reungrongrat Sanit,
Manowong Suphara,
Fanhchaksai Kanda,
Panyasit Noppamas,
Natesirinilkul Rungrote
Publication year - 2019
Publication title -
international journal of laboratory hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.705
H-Index - 55
eISSN - 1751-553X
pISSN - 1751-5521
DOI - 10.1111/ijlh.12917
Subject(s) - medicine , disseminated intravascular coagulation , thrombomodulin , thrombosis , incidence (geometry) , antithrombin , intensive care unit , gastroenterology , area under the curve , hemostasis , platelet , heparin , thrombin , physics , optics
Disseminated intravascular coagulation ( DIC ) is a systemic activation of hemostatic system caused by several causes. Biomarkers including antithrombin ( AT ), protein C ( PC ), and thrombomodulin ( TM ) were reported as the additional markers for DIC in adults. This study aimed to determine the association between biomarkers among patients with overt DIC ( ODIC ) and nonovert DIC ( NDIC ) in children in PICU . Methods We enrolled 103 subjects, aged 1 month‐18 years, who were admitted to PICU at Chiang Mai University ( CMU ) Hospital >24 hours with underlying conditions predisposing to DIC were enrolled. Biomarkers were tested after 24 hours of admission. Subject who had NDIC on the 1 st investigations would have other tests on days 3‐5 of admission. Results The incidence of ODIC by the International Society on Thrombosis and Hemostasis ( ISTH ) DIC score was found 24%. The bleeding, thrombosis, and death were significantly higher in ODIC group ( P < 0.05). Mean levels of AT and PC in ODIC group were significantly different from NDIC one (66.9% vs 79.9%, P < 0.001 and 46.1% vs 59.2%, P = 0.004, respectively) while mean level of TM was not different between two groups. Adding AT to DIC score was better than the original score for predict mortality [area under curve ( AUC ) = 0.662 vs AUC = 0.65] and bleeding ( AUC = 0.751 vs AUC = 0.732). Conclusions ODIC is prevalent among critically ill children. Adverse outcomes were more commonly found in children with ODIC . AT and PC levels after 24 hours of PICU admission seem to be the useful biomarkers for ODIC in PICU .