Journal
PEDIATRIC CRITICAL CARE MEDICINE
Volume 8, Issue 2, Pages 96-101Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/01.PCC.0000257097.42640.6F
Keywords
pediatric acute lung injury; von Willebrand factor antigen; mortality; mechanical ventilation; acute respiratory distress syndrome; biological markers
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Funding
- NCRR NIH HHS [K23 RR015543, RR15543, M01 RR001271, RR01271] Funding Source: Medline
- NHLBI NIH HHS [R01 HL051856, K08 HL070521, HL70521, R37 HL051856, HL51856, R37 HL051856-14] Funding Source: Medline
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Objective. Von Willebrand factor antigen (vWF-Ag) is a marker of pulmonary and systemic endothelial activation and injury. Adult studies indicate that patients with plasma vWF-Ag levels >= 450% of control early in the course of acute lung injury (ALI) have an increased risk of death. The objective of this study was to evaluate whether vWF-Ag is elevated in the early phase of ALI in children and whether the magnitude of the increase was predictive of two important outcomes: mortality or duration of mechanical ventilation. Design: Two-center, prospective observational study. Setting. Two pediatric intensive care units: one in an academic University setting and one in a major community children's hospital. Patients. After appropriate consent, plasma was collected from 48 pediatric patients on day I of ALI, 45 patients on day 2 of ALI, and four intubated controls. Interventions. None. Measurements and Main Results. Mean PaO2/FIO2 at the onset of ALI was 140 +/- 70, and mortality rate was 17%. vWF-Ag levels on day 1 of ALI were higher in patients compared with controls (287 +/- 183 vs. 87 +/- 84% of control [mean +/- SD], P <.05). Patients with vWF-Ag levels >= 450% of control on day 1 of ALI had a markedly greater risk of death (odds ratio, 7.0; confidence interval, 1.31, 37.30; p <.05). Multivariate analysis revealed that elevated vWF-Ag level and either presence of multiple organ system failure or Pediatric Risk of Mortality III score independently predict increased risk of death. vWF-Ag levels on day 2 of ALI were significantly higher in patients who required prolonged mechanical ventilation (316 +/- 173 vs. 191 +/- 89% of control, p <.05). Conclusions. Early injury to the systemic and pulmonary endothelium, as measured by plasma vWF-Ag levels, is associated with an increased risk of death and prolonged mechanical ventilation in pediatric patients with ALI.
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