Institute of Child Health, University of Liverpool, Alder Hey Children's National Health Service Foundation Trust, Liverpool, UK.
Pediatr Crit Care Med. 2011 Nov;12(6):e322-9. doi: 10.1097/PCC.0b013e3182231034.
A biphasic activated partial thromboplastin time waveform predicts sepsis and disseminated intravascular coagulation in adults. This has not been previously investigated in children. Our aim is to ascertain whether there are changes in the activated partial thromboplastin time waveform in children with meningococcal disease and to compare its diagnostic use with procalcitonin.
Alder Hey Children's National Health Service Foundation Trust, Liverpool, UK.
Thirty-six children admitted to the hospital for the treatment of suspected meningococcal disease had activated partial thromboplastin time waveform and procalcitonin analysis performed at admission. The light transmittance level at 18 secs was used to quantitate the waveform. Severity of disease was assessed using the Glasgow Meningococcal Septicaemia Prognostic Score, Pediatric Risk of Mortality III score, and the Pediatric Logistic Organ Dysfunction score.
Twenty-four children had proven meningococcal disease, 12 had a presumed viral illness, and 20 control subjects were recruited. Transmittance level at 18 secs was lower in children with meningococcal disease and those with a viral illness (p < .0001) and control subjects (p < .0005). Sensitivity and specificity was 0.91 and 0.96 for transmittance level at 18 secs and 0.92 and 1 for procalcitonin in identifying meningococcal disease. There was a significant difference in procalcitonin between children with meningococcal disease and those with a viral illness and control subjects (p < .0005). A negative correlation was found between transmittance level at 18 secs and length of hospital stay (p < .0001), C-reactive protein (p < .0001), procalcitonin (p < .0001), Glasgow Meningococcal Septicaemia Prognostic Score (p < .01), Pediatric Risk of Mortality III score (p < .0001), and Pediatric Logistic Organ Dysfunction score score (p < .0001).
The activated partial thromboplastin time waveform is abnormal in children with meningococcal disease and may be a useful adjunct in the diagnosis and management of sepsis in children.
双相激活部分凝血活酶时间波形可预测成人脓毒症和弥散性血管内凝血。这在儿童中尚未得到过研究。我们的目的是确定脑膜炎奈瑟菌病患儿的激活部分凝血活酶时间波形是否有变化，并比较其与降钙素原的诊断用途。
英国利物浦的奥尔德·赫伊儿童国民保健服务基金会信托。
36 名因疑似脑膜炎奈瑟菌病入院的患儿入院时进行了激活部分凝血活酶时间波形和降钙素原分析。使用 18 秒时的透光率水平来定量波形。使用格拉斯哥脑膜炎球菌败血病预后评分、儿科死亡率 III 评分和儿科逻辑器官功能障碍评分评估疾病严重程度。
24 名患儿患有确诊的脑膜炎奈瑟菌病，12 名患儿患有疑似病毒性疾病，20 名对照患儿入选。脑膜炎奈瑟菌病患儿和病毒性疾病患儿（p<0.0001）和对照患儿（p<0.0005）的 18 秒透光率水平较低。18 秒时的透光率水平在识别脑膜炎奈瑟菌病方面的灵敏度和特异性为 0.91 和 0.96，降钙素原的灵敏度和特异性为 0.92 和 1。脑膜炎奈瑟菌病患儿与病毒性疾病患儿和对照患儿之间降钙素原存在显著差异（p<0.0005）。18 秒时的透光率水平与住院时间（p<0.0001）、C 反应蛋白（p<0.0001）、降钙素原（p<0.0001）、格拉斯哥脑膜炎球菌败血病预后评分（p<0.01）、儿科死亡率 III 评分（p<0.0001）和儿科逻辑器官功能障碍评分（p<0.0001）呈负相关。
脑膜炎奈瑟菌病患儿的激活部分凝血活酶时间波形异常，可能有助于诊断和治疗儿童脓毒症。
