Hemostasis Proteins in Invasive Meningococcal and Nonmeningococcal Infections: A Prospective Multicenter Study

Area of Science:

• Pediatric Infectious Diseases
• Hematology
• Critical Care Medicine

Background:

• Bacterial infections in children can lead to significant hemostatic disturbances.
• Understanding variations in hemostasis proteins across different pathogens is crucial for assessing disease severity and outcomes.
• Previous research has primarily focused on meningococcal sepsis, leaving gaps in knowledge regarding other common pediatric bacterial infections.

Purpose of the Study:

• To investigate the variability of key hemostasis proteins in children with bacterial infections caused by Neisseria meningitidis, Streptococcus pneumoniae, Staphylococcus aureus, and group A Streptococcus (GAS).
• To evaluate the association between hemostasis protein levels and in-hospital mortality in pediatric patients with these infections.
• To compare hemostatic protein profiles across different bacterial pathogens.

Main Methods:

• Prospective cohort study involving 241 children admitted with community-acquired bacterial infections across five European countries.
• Measurement of serum fibronectin, plasminogen activator inhibitor type 1 (PAI-1), thrombomodulin, and ADAMTS-13.
• Measurement of plasma von Willebrand factor, protein C, protein S, and factor IX in a subset of patients.
• Analysis of in-hospital mortality, disease severity (ventilation/inotropes), and Pediatric Index of Mortality score.

Main Results:

• Mortality rates were comparable across pathogen groups (8.7% overall).
• Significant differences in fibronectin and thrombomodulin levels were observed between pathogens (p < 0.05).
• Thrombomodulin and ADAMTS-13 demonstrated good discriminative ability for mortality (AUC 0.81 and 0.78, respectively).

Conclusions:

• Hemostatic disturbances are prevalent in pediatric bacterial infections, extending beyond meningococcal sepsis to comparable severity in non-meningococcal infections.
• Elevated levels of thrombomodulin and ADAMTS-13 are significant predictors of mortality in critically ill children with bacterial infections.
• These findings underscore the importance of monitoring hemostasis in managing pediatric bacterial infections, regardless of the causative pathogen.