Catalogo Articoli (Spogli Riviste)

OPAC HELP

Titolo:
COAGULOPATHY AS A PREDICTOR OF OUTCOME IN MENINGOCOCCAL SEPSIS AND THE SYSTEMIC INFLAMMATORY RESPONSE SYNDROME WITH PURPURA
Autore:
MCMANUS ML; CHURCHWELL KB;
Indirizzi:
CHILDRENS HOSP MED CTR,MULTIDISCIPLINARY INTENS CARE UNIT,MICU OFF,FARLEY 517 BOSTON MA 02115
Titolo Testata:
Critical care medicine
fascicolo: 5, volume: 21, anno: 1993,
pagine: 706 - 711
SICI:
0090-3493(1993)21:5<706:CAAPOO>2.0.ZU;2-F
Fonte:
ISI
Lingua:
ENG
Soggetto:
SEVERE INFECTIOUS PURPURA; PROGNOSTIC FACTORS; FULMINANS; SCORE; CHILD;
Keywords:
SEPSIS; SHOCK; PURPURA; MENINGOCOCCUS; COAGULATION; MORBIDITY; PEDIATRIC INTENSIVE CARE UNIT; PATIENT OUTCOME ASSESSMENT; SEVERITY OF ILLNESS INDEX; CRITICAL ILLNESS; FIBRINOGEN;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
18
Recensione:
Indirizzi per estratti:
Citazione:
M.L. Mcmanus e K.B. Churchwell, "COAGULOPATHY AS A PREDICTOR OF OUTCOME IN MENINGOCOCCAL SEPSIS AND THE SYSTEMIC INFLAMMATORY RESPONSE SYNDROME WITH PURPURA", Critical care medicine, 21(5), 1993, pp. 706-711

Abstract

Objective: To identify simple, contemporary predictors of both morbidity and mortality in pediatric patients with purpuric sepsis syndrome in order to provide a basis for future study of innovative interventions. Design: Retrospective study. Setting: An 18-bed multidisciplinary intensive care unit (ICU) in a large pediatric hospital. Patients: A total of 53 patients, ranging in age from 18 days to 17 yrs (mean 4.9 yrs) with either culture-proven meningococcal sepsis or the systemic inflammatory response syndrome with purpura, who were admitted to the ICU during the period from January 1, 1982 through March 15,1992. Methods: A computerized database was constructed containing the characteristics of these patients at presentation, during the first 24 hrs of hospitalization, and on discharge. Single variables were screened for significance between ''good'' (intact survival) and ''poor'' (mortality orsurvival with significant morbidity) outcome groups. Those variables found to be most significant were then tested for sensitivity, specificity, and predictive value. The best predictors identified in this manner were then compared with the two most-cited prognosticating strategies as applied to these patients. Measurements and Main Results: Coagulopathy (defined as a partial thromboplastin time >50 secs or serum fibrinogen concentration <150 mg/dL [4.4 mumol/L]) at the referral site or on ICU admission was identified as an excellent predictor of poor outcome: sensitivity, specificity, positive and negative predictive values of a low serum fibrinogen value, being 81%, 95%, 93%, and 88%, andof prolonged partial thromboplastin time, being 95%, 90%, 86%, and 97%, respectively. Classical prognosticating strategies were found to beinadequately associated with mortality, yet comparable with coagulopathy in identifying patients destined for clinically important morbidity. Conclusions: We conclude that: a) outcome of pediatric patients with meningococcal sepsis or the systemic inflammatory response syndrome with purpura can be predicted rapidly, more easily, and with overall accuracy superior to classical prognostication strategies by the simplepresence or absence of coagulopathy; b) when applied to a contemporary population, classical prognostication strategies lack value for prediction of mortality, yet remain valid for prediction of ''poor outcome'' (significant morbidity + mortality); c) when evaluating treatment strategies for such patients, the presence of serious coagulopathy may potentially be useful as an index of illness severity.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 21/01/20 alle ore 01:09:09