The predictive value of Von Willebrand factor antigen plasma levels in children with acute lung injury.

OBJECTIVE

Von Willebrand factor antigen (VWF-Ag) is proved to be a marker for pulmonary endothelial injury in acute lung injury (ALI). We aimed to evaluate the predictive value of VWF-Ag plasma levels in children with ALI.

METHODS

Prospective controlled study included 40 children with ALI as a patient group, 40 healthy children as a control group. Plasma VWF Ag level was measured at days 1 and 3 in patient group and measured once for control group.

RESULTS

The commonest cause of ALI was pneumonia (35%). VWF Ag plasma levels were significantly higher in patient group than control group at days 1 and 3 (P = 0.001 and 0.002), respectively. Mean PaO /FiO of patients with ALI was 137 ± 65.38. Mortality was 30%. The deceased subgroup had significantly higher plasma levels of VWF Ag at days 1 and 3 than survived subgroup (P = 0.016 and P < 0.0001, respectively), significantly higher C reactive protein (P = 0.001), significantly higher rate of multisystem organ failure (MSOF) (P = 0.001), shorter duration of pediatric intensive care unit (PICU), and mechanical ventilation (MV) free days (P < 0.0001). Elevated VWF at day 1 was associated with significant MSOF (P = 0.011) and mortality (P = 0.009), while elevated VWF Ag at day 3 was associated with significant increase in MSOF (P = 0.004), length of MV (P = 0.024), and PICU stay (P = 0.011). VWF Ag has a high sensitivity (94.2%, 93.4%) and specificity (83.1%, 81.7%) for prediction of mortality at days 1 and 3, respectively. Multivariate regression analysis revealed that plasma VWF Ag level is an independent predictor of mortality in ARDS pediatric patients.

CONCLUSION

Plasma VWF Ag level is an excellent predictive marker for outcome in children with ALI/ARDS. Pediatr Pulmonol. 2017;52:91-97. © 2016 Wiley Periodicals, Inc.