Korean Journal of Pediatrics 2007;50(5):443-448.
Published online May 15, 2007.
Antithrombin-III as an early prognostic factor in children with acute lung injury
Young Seung Lee, Seonguk Kim, Eun Kyeong Kang, June Dong Park
Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
급성 폐손상 소아 환자에서 조기 예후 인자로서의 antithrombin-III
이영승, 김성국, 강은경, 박준동
서울대학교 의과대학 소아과학교실
Correspondence: 
June Dong Park, Email: jdparkmd@snu.ac.kr
Abstract
Purpose
: To evaluate the potential prognostic value of the antithrombin-III (AT-III) level in the children with acute lung injury (ALI), we analyzed several early predictive factors of death including AT-III level at the onset of ALI and compared the relative risk of them for mortality.
Methods
: Over a 18-month period, a total of 198 children were admitted to our pediatric intensive care unit and 21 mechanically ventilated patients met ALI criteria, as defined by American-European consensus conference, i.e., bilateral pulmonary infiltrates and PaO2/FiO2 lower than 300 without left atrial hypertension. Demographic variables, hemodynamic and respiratory parameters, underlying diseases, as well as Pediatric Risk of Mortality-III (PRISM-III) scores and Lung Injury Score (LIS) at admission were collected. AT-III levels were measured within 3 hours after admission. These variables were compared between survivors and non-survivors and entered into a multiple logistic regression analysis to evaluate their independent prognostic roles.
Results
: The overall mortality rate was 38.1% (8/21). Non-survivors showed lower age, lower lung compliance, higher PEEP, higher oxygenation index (OI), lower arterial pH, lower PaO2/FiO2, higher PRISM-III score and LIS, and lower AT-III level. PRISM-III score, LIS, OI and decreased AT-III level (less than 70%) were independently associated with a risk of death and the odds ratio of decreased AT-III level for mortality is 2.75 (95% confidence interval; 1.28-4.12)
Conclusion
: These results suggest that the decreased level of AT-III is an important prognostic factor in children with ALI and the replacement of AT-III may be considered as an early therapeutic trial.
Key Words: Acute lung injury, Mortality, Prognostic factor, Antithrombin-III


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