Enhanced thrombin generation in patients receiving intensive care

Area of Science:

• Biochemistry
• Pediatric Critical Care
• Hematology

Background:

• Thrombin generation is a key indicator of coagulation activation.
• Disseminated intravascular coagulation (DIC) is a life-threatening condition characterized by widespread activation of coagulation.
• Assessing thrombin generation in critically ill children is crucial for timely diagnosis and management.

Purpose of the Study:

• To establish normal reference ranges for thrombin-antithrombin III complex (TAT) in children.
• To evaluate thrombin generation in critically ill pediatric patients.
• To determine the diagnostic utility of the TAT assay for disseminated intravascular coagulation (DIC) in children.

Main Methods:

• Measurement of TAT complex concentrations in 27 control and 155 intensive care patients.
• Statistical analysis to establish reference ranges and compare TAT levels between patients with and without DIC.
• Calculation of sensitivity, specificity, and predictive values for the TAT assay at a defined cutoff.

Main Results:

• The normal reference range for TAT was determined to be 1-4.3 micrograms/l (median 2.3 micrograms/l).
• Elevated TAT concentrations were observed in 89.7% of intensive care patients.
• Median TAT levels were significantly higher in patients with DIC (27 micrograms/l) compared to those without (8 micrograms/l).
• The TAT assay demonstrated high sensitivity (97.3%) and negative predictive value (81.3%) at a cutoff of 4 micrograms/l for DIC diagnosis.

Conclusions:

• Critically ill children frequently exhibit excessive thrombin production.
• The thrombin-antithrombin III complex (TAT) assay is a valuable tool for diagnosing disseminated intravascular coagulation (DIC) in pediatric intensive care settings.
• The TAT assay's high sensitivity suggests its utility in ruling out DIC when levels are within the normal range.