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Value of Thrombomodulin as a Marker for Sepsis in Critically Ill Children
Ahmed Anwar Khattab1, Ashraf Abd El Raouf Dawood2, Nagwan Yossery Saleh3
1Department of Pediatrics, Faculty of Medicine, Menoufia University Hospital, Menoufia Governorate, Shibin El Kom, Egypt.
Insights
Serum thrombomodulin shows promise as a biomarker for diagnosing pediatric sepsis in critically ill children. Elevated levels indicate sepsis and are associated with mortality, aiding early detection.
Area of Science:
- Pediatric critical care medicine
- Biomarker research
- Sepsis diagnostics
Background:
- Pediatric sepsis, characterized by organ dysfunction, is a leading cause of mortality in critically ill children.
- Early and accurate diagnosis is crucial for effective management and improved outcomes.
Purpose of the Study:
- To evaluate serum thrombomodulin as a diagnostic and prognostic biomarker for sepsis in acutely ill pediatric patients.
- To compare the diagnostic accuracy of thrombomodulin with C-reactive protein and established scoring systems.
Main Methods:
- Prospective study of 140 pediatric patients in an intensive care unit and 50 healthy controls.
- Measurement of serum thrombomodulin levels upon admission.
- Calculation of Pediatric Risk of Mortality (PRISM) and Pediatric Index of Mortality II (PIM II) scores.
Main Results:
- Serum thrombomodulin levels were significantly elevated in patients with sepsis compared to controls (p < 0.001).
- Higher thrombomodulin levels were observed in non-survivors (p = 0.005).
- Thrombomodulin demonstrated strong diagnostic accuracy for sepsis (AUC = 0.915), outperforming C-reactive protein (AUC = 0.789).
Conclusions:
- Serum thrombomodulin is a valuable and promising biomarker for the early diagnosis of sepsis in critically ill children.
- It aids in identifying sepsis and holds prognostic value for mortality prediction.
Objective:
Pediatric sepsis is altered organ function in critically ill children and a main etiology of mortality for children. Therefore, the authors aimed to assess the role of serum thrombomodulin as valuable biomarker in the diagnosis and prognosis of sepsis in acutely ill pediatrics in the intensive unit.
Methods:
This prospective clinical study conducted on 140 acutely ill patients admitted to the Pediatric Intensive Care Unit (PICU) of Menoufia University Hospital and 50 apparently healthy controls from October 2018 through September 2019. All included children were subjected to clinical examination and the Pediatric Risk of Mortality (PRISM) and Pediatric Index of Mortality II (PIM II) scores were calculated. Serum thrombomodulin was measured for both patients and the control group upon admission. The children were followed for a period of 30 d.
Results:
Serum thrombomodulin level was increased among all the patients and those with systemic inflammatory response syndrome (SIRS), sepsis and severe sepsis compared with controls (p < 0.001). Furthermore, serum thrombomodulin was higher in patients who died than who survived (p = 0.005). Thrombomodulin had area under Receiver Operating Characteristic Curve (AUC) =0.915 for predicting sepsis, whereas C-reactive protein had AUC = 0.789. According to the prognosis, thrombomodulin had AUC = 0.711 for predicting mortality whereas PRISM and PIM scores had AUC = (0.918, 0.960) respectively.
Conclusions:
Serum thrombomodulin is a promising marker for pediatric sepsis. The data showed that serum thrombomodulin had a valuable role in diagnosis of sepsis early in critically ill pediatrics.
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