Coagulopathy as a prognostic factor of acute lung injury in children

Area of Science:

• Pediatric critical care medicine
• Hematology
• Pulmonology

Background:

• Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) involve complex pathophysiology including inflammation and coagulation.
• Coagulopathy, a disruption of the normal blood clotting process, is frequently observed in critically ill children.

Purpose of the Study:

• To investigate the association between laboratory markers of coagulopathy and clinical outcomes in pediatric patients diagnosed with ALI/ARDS.
• To determine if prothrombin time (PT) and activated partial thromboplastin time (APTT) can serve as prognostic indicators in this population.

Main Methods:

• Retrospective analysis of laboratory values (PT, APTT) within 24 hours of ALI/ARDS diagnosis in 79 mechanically ventilated children.
• Outcomes assessed included overall survival (OS) and non-pulmonary organ failure-free survival (FFS).
• Multivariate analysis was performed, stratifying by oxygenation index and ventilation index.

Main Results:

• Non-survivors exhibited significantly prolonged PT and APTT compared to survivors.
• Prolonged PT (≥ 1.46 INR) was associated with lower FFS, while prolonged APTT (≥ 50 seconds) correlated with lower OS and FFS, particularly in specific subgroups.
• Both prolonged PT and APTT were independently associated with decreased OS and FFS across different ventilation severity strata.

Conclusions:

• Elevated PT and APTT are significant indicators of coagulopathy in mechanically ventilated children with ALI/ARDS.
• These coagulation parameters demonstrate prognostic value, predicting mortality and reduced survival-free periods in pediatric ALI/ARDS.
• PT and APTT should be considered valuable prognostic factors for children with ALI/ARDS.