因子VIII可能预测危重症儿童的导管相关血栓形成：一项初步研究。
Factor VIII May Predict Catheter-Related Thrombosis in Critically Ill Children: A Preliminary Study.
作者信息
Faustino Edward Vincent S, Li Simon, Silva Cicero T, Pinto Matthew G, Qin Li, Tala Joana A, Rinder Henry M, Kupfer Gary M, Shapiro Eugene D
机构信息
1Department of Pediatrics, Yale School of Medicine, New Haven, CT. 2Pediatric Intensive Care Unit, Maria Fareri Children's Hospital, Valhalla, NY. 3Department of Diagnostic Radiology, Yale School of Medicine, New Haven, CT. 4Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT. 5Pediatric Intensive Care Unit, Yale-New Haven Hospital, New Haven, CT. 6Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT. 7Department of Internal Medicine, Yale School of Medicine, New Haven, CT. 8Department and of Pathology, Yale School of Medicine, New Haven, CT. 9Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT. 10Department of Investigative Medicine, Yale Graduate School of Arts and Sciences, New Haven, CT.
出版信息
Pediatr Crit Care Med. 2015 Jul;16(6):497-504. doi: 10.1097/PCC.0000000000000409.
OBJECTIVE
If we can identify critically ill children at high risk for central venous catheter-related thrombosis, then we could target them for pharmacologic thromboprophylaxis. We determined whether factor VIII activity or G value was associated with catheter-related thrombosis in critically ill children.
DESIGN
Prospective cohort study.
SETTING
Two tertiary academic centers.
PATIENTS
We enrolled children younger than 18 years who were admitted to the PICU within 24 hours after insertion of a central venous catheter. We excluded children with a recently diagnosed thrombotic event or those anticipated to receive anticoagulation. Children with thrombosis diagnosed with surveillance ultrasonography on the day of enrollment were classified as having prevalent thrombosis. Those who developed catheter-related thrombosis thereafter were classified as having incident thrombosis.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
We enrolled 85 children in the study. Once enrolled, we measured factor VIII activity with one-stage clotting assay and determined G value with thromboelastography. Of those enrolled, 25 had incident and 12 had prevalent thromboses. The odds ratio for incident thrombosis per SD increase in factor VIII activity was 1.98 (95% CI, 1.10-3.55). The area under the receiver operating characteristic curve was 0.66 (95% CI, 0.52-0.79). At factor VIII activity more than 100 IU/dL, which was the optimal threshold identified using Youden index, sensitivity and specificity were 92.0% and 41.3%, respectively. The association between factor VIII activity and incident thrombosis remained significant after adjusting for important clinical predictors of thrombosis (odds ratio, 1.93; 95% CI, 1.10-3.39). G value was associated with prevalent but not with incident thrombosis.
CONCLUSION
Factor VIII activity may be used to stratify critically ill children based on their risk for catheter-related thrombosis.
目的
如果我们能够识别出有中心静脉导管相关血栓形成高风险的危重症儿童，那么我们就可以将药物性血栓预防措施应用于这些儿童。我们确定了因子VIII活性或G值是否与危重症儿童的导管相关血栓形成有关。
设计
前瞻性队列研究。
地点
两家三级学术中心。
患者
我们纳入了在插入中心静脉导管后24小时内入住儿科重症监护病房（PICU）的18岁以下儿童。我们排除了近期诊断有血栓形成事件的儿童或预计会接受抗凝治疗的儿童。在入组当天通过超声监测诊断为血栓形成的儿童被归类为有既往血栓形成。此后发生导管相关血栓形成的儿童被归类为有新发血栓形成。
干预措施
无。
测量指标及主要结果
我们共纳入了85名儿童进行研究。入组后，我们采用一期凝血试验测量因子VIII活性，并通过血栓弹力图测定G值。在这些入组儿童中，25名有新发血栓形成，12名有既往血栓形成。因子VIII活性每增加1个标准差，新发血栓形成的比值比为1.98（95%置信区间，1.10 - 3.55）。受试者工作特征曲线下面积为0.66（95%置信区间，0.52 - 0.79）。使用约登指数确定的最佳阈值为因子VIII活性超过100 IU/dL时，敏感性和特异性分别为92.0%和41.3%。在对血栓形成的重要临床预测因素进行校正后，因子VIII活性与新发血栓形成之间的关联仍然显著（比值比，1.93；95%置信区间，1.10 - 3.39）。G值与既往血栓形成有关，但与新发血栓形成无关。
结论
因子VIII活性可用于根据危重症儿童发生导管相关血栓形成的风险进行分层。
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