Related Experiment Video
Updated: Feb 2, 2026
How to Administer Near-Infrared Spectroscopy in Critically ill Neonates, Infants, and Children
Published on: August 19, 2020
Inflammatory and coagulatory parameters linked to survival in critically ill children with sepsis
Christian Niederwanger1, Mirjam Bachler2, Tobias Hell3
1Department of Pediatrics, Pediatrics I, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
Insights
High fibrinogen and platelet levels, along with normal activated partial thromboplastin time (aPTT), improve survival in pediatric sepsis. Low fibrinogen indicates a high mortality risk in critically ill children.
Area of Science:
- Pediatric critical care medicine
- Hematology
- Infectious diseases
Background:
- Sepsis involves complex inflammatory and coagulative responses.
- Clotting factors play a role in host defense against infection and inflammation.
- These parameters may serve as prognostic markers in pediatric sepsis.
Purpose of the Study:
- To identify predictors of in-hospital mortality in critically ill children with sepsis.
- To analyze routinely measured parameters at peak C-reactive protein levels.
- To evaluate the prognostic value of coagulation parameters in pediatric sepsis.
Main Methods:
- Retrospective analysis of 250 critically ill pediatric patients with sepsis.
- Identification of predictors for in-hospital mortality.
- Multivariate logistic regression and decision tree analysis were employed.
Main Results:
- Fibrinogen, platelets, and activated partial thromboplastin time (aPTT) at peak C-reactive protein levels predicted survival.
- Increased fibrinogen and platelets correlated with survival.
- aPTT prolongation was associated with increased mortality; low fibrinogen (<192 mg/dl) was highly indicative of non-survival.
Conclusions:
- Elevated fibrinogen and platelet levels, and a normal aPTT, are linked to better survival rates in pediatric sepsis.
- Hypofibrinogenemia is a significant indicator of mortality in critically ill septic children.
- Coagulation parameters are valuable prognostic indicators in pediatric sepsis.
Background:
Sepsis is associated with a deflection of inflammatory and coagulative parameters, since some clotting factors are known to be involved in the host's defense against infection and inflammation. These parameters could play a crucial role in the course of sepsis and be used as prognostic markers in critically ill children.
Methods:
A total of 250 critically ill pediatric patients diagnosed with sepsis were retrospectively analyzed to identify routinely measured predictors for in-hospital mortality at the peak level of C-reactive protein. Those parameters entered multivariate logistic regression analysis as well as a decision tree for survival.
Results:
Multivariate logistic regression analysis revealed fibrinogen, platelets and activated partial thromboplastin time (aPTT) at the peak level of C-reactive protein to be predictors for survival (p = 0.03, p = 0.01 and p = 0.02, respectively). An increase in fibrinogen and platelets is linked to survival, whereas an aPTT prolongation is associated with higher mortality; adjusted odds ratios (95% CI) for an increase of 100 mg/dl in fibrinogen are 1.35 (1.04-1.82) per 50 G/l platelets 1.94 (1.3-3.29) and 0.83 (0.69-0.96) for an aPTT prolongation of 10 s. Decision tree analysis shows that a fibrinogen level below 192 mg/dl (90.9% vs. 13% mortality) is most distinctive in non-survivors.
Conclusions:
High levels of fibrinogen and platelets as well as a non-overshooting aPTT are associated with a higher survival rate in pediatric patients with diagnosed sepsis. In particular, hypofibrinogenemia is distinctive for a high mortality rate in septic critically ill children.
Related Concept Videos
02:04Covalently Linked Protein Regulators
These groups modify specific amino acids in a protein....
01:16Critical Region, Critical Values and Significance Level
In hypothesis testing, a sample statistic is converted to a test statistic using z, t, or chi-square distribution. A critical region is an area under the curve in probability distributions demarcated by the critical value. When the test statistic falls in this region, it suggests that the null hypothesis must be rejected. As this region contains all those values of the...
01:31Critical Values
01:18Survival Curves
The Kaplan-Meier estimator is the most common method for constructing survival curves. This...
01:19Survival Tree
Building a Survival Tree
Constructing a...
01:28Inflammatory Response
Inflammation can be triggered by various stimuli, such as impact, abrasion, chemical irritation, infections, and extreme hot or cold temperatures. These can damage cells and connective tissue fibers,...