Venkataseshan Sundaram, Dutta Sourabh, Ahluwalia Jasmina, Narang Anil
Department of Pediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Pediatr Infect Dis J. 2007 Aug;26(8):684-8. doi: 10.1097/INF.0b013e3180f616f0.
Septicemia activates coagulation and decreases activated protein C (APC). Low APC in adults is associated with multiorgan dysfunction and mortality, but such data in neonates are lacking. Being deficient in APC, neonates may be especially vulnerable to the effects of low APC.
This cohort study was conducted on 40 neonates with severe bacterial septicemia to determine the relationship between plasma APC values and mortality, time to mortality, and hazard of dying. Low birth weight neonates with sepsis, organ dysfunction, and systemic inflammatory response syndrome were enrolled after parental consent. Plasma APC was assayed at enrollment and subjects were followed for 14 days from enrollment. Low birth weight neonates, who had major malformations, severe birth asphyxia, or received blood products before APC assay, were excluded.
comparison of APC level between survivors and nonsurvivors.
survival with low versus normal APC; and hazard ratio of APC, adjusted for birth weight, Score for Neonatal Acute Physiology and number of affected organs.
Forty of 74 eligible neonates were included. Twenty-five of the enrolled neonates died within 14 days. APC levels in nonsurvivors were lower than in survivors [median (interquartile range) %, 15 (4.5-21) versus 33 (18-55); P < 0.001]. Ten nonsurvivors versus 1 survivor had low APC (P = 0.03). Positive predictive value (PPV) of low APC values for mortality was 90.9%. Survival in the low APC group (n = 11) was shorter than in normal APC group [median (95% confidence interval) days, 3 (2.3-3.7) versus 10, P value <0.001]. APC value was independently associated with hazard of dying [adjusted risk 0.95 (95% confidence interval 0.92-0.99), P = 0.02]. Each 1% rise in APC decreased the hazard of dying by 5%.
Mortality was higher and duration of survival shorter in septic neonates with lower plasma ACP. The latter was an independent predictor of the hazard of dying.
败血症会激活凝血并降低活化蛋白C（APC）。成人中低APC水平与多器官功能障碍和死亡率相关，但新生儿方面缺乏此类数据。由于新生儿缺乏APC，他们可能特别容易受到低APC影响。
本队列研究对40例患有严重细菌性败血症的新生儿进行，以确定血浆APC值与死亡率、死亡时间和死亡风险之间的关系。在获得家长同意后，纳入患有败血症、器官功能障碍和全身炎症反应综合征的低出生体重新生儿。在入组时检测血浆APC，并从入组开始对受试者进行14天的随访。排除患有严重畸形、严重出生窒息或在APC检测前接受过血液制品的低出生体重新生儿。
比较幸存者和非幸存者的APC水平。
低APC与正常APC情况下的生存率；以及校正出生体重、新生儿急性生理学评分和受累器官数量后的APC风险比。
74例符合条件的新生儿中有40例被纳入。25例入组新生儿在14天内死亡。非幸存者的APC水平低于幸存者[中位数（四分位间距）%，15（4.5 - 21）对33（18 - 55）；P < 0.001]。10例非幸存者与1例幸存者的APC水平较低（P = 0.03）。低APC值对死亡率的阳性预测值（PPV）为90.9%。低APC组（n = 11）的生存时间短于正常APC组[中位数（95%置信区间）天，3（2.3 - 3.7）对10，P值<0.001]。APC值与死亡风险独立相关[校正风险0.95（95%置信区间0.92 - 0.99），P = 0.02]。APC每升高1%，死亡风险降低5%。
血浆ACP水平较低的败血症新生儿死亡率更高，生存时间更短。后者是死亡风险的独立预测因素。
