Lapland Central Hospital, 96400 Rovaniemi, Finland.
Department of Paediatrics, Riga Stradins University, LV1007 Riga, Latvia.
Medicina (Kaunas). 2019 Aug 20;55(8):503. doi: 10.3390/medicina55080503.
: In children, acute infection is the most common cause of visits in the primary care or emergency department. In 2002, criteria for diagnostics of pediatric sepsis were published, and then revised in 2016 as "life-threatening organ dysfunction due to a dysregulated host response to infection". In the pathophysiology of sepsis endothelial dysfunction plays a very important role. Deficient proteolysis of von Willebrand factor, due to reduced ADAMTS-13 activity, results in disseminated platelet-rich thrombi in the microcirculation. ADAMTS-13 deficiency has been detected in systemic inflammation. The clinical relevance of ADAMTS-13 during sepsis is still unclear. We aimed to investigate the possible use of ADAMTS-13 as a prognostic marker in children with serious bacterial infection (SBI). Inclusion criteria were hospitalized children with SBI, aged from 1 month to 17 years. SBI was defined based on available clinical, imaging, and later also on microbiological data. Sepsis was diagnosed using criteria by The International Consensus Conference. In all the patients, the levels of ADAMTS-13 were measured at the time of inclusion. Data from 71 patients were analyzed. A total of 47.9% (34) had sepsis, 21.1% (15) were admitted to the ICU, 8.5% (6) had mechanical ventilator support, and 4.2% (3) patients had a positive blood culture. The median level of ADAMTS-13 in this study population was 689.43 ng/mL. Patients with sepsis, patients admitted to the Intensive Care Unit, and patients in need of mechanical ventilator support had significantly lower levels of ADAMTS-13. None of the patients had ADAMTS-13 deficiency. In patients with SBI, the area under the curve (AUC) to predict sepsis was 0.67. A cut-off ADAMTS-13 level of ≤730.49 had 82% sensitivity and 60% specificity for sepsis in patients with SBI. ADATMS-13 levels were lower in patients with SBI and sepsis, but AUC and sensitivity were too low to accept it as a prognostic marker.
在儿童中，急性感染是导致其前往初级保健或急诊部门就诊的最常见原因。2002 年，发布了儿科脓毒症的诊断标准，并于 2016 年修订为“感染导致宿主反应失调而危及生命的器官功能障碍”。在脓毒症的病理生理学中，内皮功能障碍起着非常重要的作用。由于 ADAMTS-13 活性降低，导致 von Willebrand 因子的蛋白水解不足，从而在微循环中形成弥散性富含血小板的血栓。在全身炎症中已检测到 ADAMTS-13 缺乏。ADAMTS-13 在脓毒症中的临床相关性尚不清楚。我们旨在研究 ADAMTS-13 是否可作为严重细菌性感染（SBI）患儿的预后标志物。
纳入标准为患有 SBI 的住院患儿，年龄 1 个月至 17 岁。SBI 基于现有临床、影像学和后来的微生物学数据定义。脓毒症使用国际共识会议的标准进行诊断。在所有患者中，在纳入时均测量 ADAMTS-13 水平。
共分析了 71 例患者的数据。共有 47.9%（34 例）患有脓毒症，21.1%（15 例）入住 ICU，8.5%（6 例）需要机械通气支持，4.2%（3 例）患者血培养阳性。该研究人群的 ADAMTS-13 中位数水平为 689.43ng/ml。患有脓毒症、入住 ICU 和需要机械通气支持的患者的 ADAMTS-13 水平明显较低。没有患者存在 ADAMTS-13 缺乏症。在 SBI 患者中，预测脓毒症的曲线下面积（AUC）为 0.67。在 SBI 患者中，ADAMTS-13 截断值≤730.49 时，对脓毒症的灵敏度为 82%，特异性为 60%。
在患有 SBI 的患者中，ADATMS-13 水平较低，且脓毒症患者的水平更低，但 AUC 和灵敏度均较低，无法将其作为预后标志物接受。
