Coagulation Dysfunction Criteria in Critically Ill Children: The PODIUM Consensus Conference

Faustino, E. Vincent S.; Karam, Oliver; Parker, Robert I.; Hanson, Sheila J.; Brandão, Leonardo R.; Monagle, Paul

doi:10.1542/peds.2021-052888l

Cited by 5 publications

(4 citation statements)

References 29 publications

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“…We also found that Fib was a protective factor for critical illness in children, indicating that the decreased Fib level (<1.48 g/L) was relative to the poor prognosis of critically ill children. This is consistent with a previous study for pediatric critical illness which recommended that the low level of Fib (<1.50 g/L) was linked to high mortality (29). Nonetheless, Bredbaca et al (30) reported that patients with early signs of hypercoagulation, as evaluated by elevated fibrin levels, would experience more organ failure and have higher in-hospital mortality compared to those with normal fibrin levels in ICU patients.…”

Section: Discussionsupporting

confidence: 88%

Elevated plasma D-dimer levels are associated with the poor prognosis of critically ill children

Wang

Liu

et al. 2022

Front. Pediatr.

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BackgroundD-dimer has been shown as a valuable predictor for the prognosis of sepsis. But the prognostic association of an elevated D-dimer with adverse outcomes of all critical illnesses in pediatric intensive care unit (PICU) has received far less emphasis.MethodsThis was a single-center retrospective study, including 7,648 critical patients aged between 28 days and 18 years from the pediatric intensive care (PIC) database from 2010 to 2018. The primary outcome was the in-hospital mortality rate.ResultsHigher levels of D-dimer, INR, PT, APTT, and lower Fib were observed in the non-survivor group (all P < 0.001). D-dimer, INR, PT and APTT were independent risk factors for prognosis in critically ill children. There was the highest AUROC in D-dimer for predicting in-hospital mortality of critically ill patients compared with INR, PT, APTT, and Fib (D-dimer: 0.77 vs. INR: 0.73 vs. PT: 0.73 vs. APTT: 0.64 vs. Fib: 0.60). The cut-off value, sensitivity, and specificity of D-dimer were 1.53, 0.65, and 0.77, respectively. Subgroup analysis showed a stable evaluation effectiveness of D-dimer for predicting in-hospital mortality of critically ill patients in the age and gender groups.ConclusionsWe found poorer coagulation function in the non-survivors compared with the survivors. Among the coagulation indicators, D-dimer was most strongly associated with in-hospital mortality of unselected critically ill children.

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Section: Discussionsupporting

confidence: 88%

Elevated plasma D-dimer levels are associated with the poor prognosis of critically ill children

Wang

Liu

et al. 2022

Front. Pediatr.

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“…Concurrent thrombocytopenia was nearly ubiquitous among those with abnormal clotting parameters that received treatment. Coagulation dysfunction criteria in critically ill children were recently proposed following systematic review as part of the PODIUM Consensus Conference ( 30 ). Importantly, this comprehensive work was not intended for the preterm or NICU population.…”

Section: Discussionmentioning

confidence: 99%

The frequency and timing of sepsis-associated coagulopathy in the neonatal intensive care unit

Aziz,

Saxonhouse,

Mahesh

et al. 2024

Front. Pediatr.

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IntroductionSepsis is a common cause of morbidity and mortality in the neonatal intensive care unit (NICU). The frequency and severity of sepsis-associated coagulopathy as well as its relationship to illness severity are unclear.MethodsWe performed a single-center, retrospective, observational cohort study of all infants admitted to the University of Florida Health (UF Health), level IV NICU between January 1st 2012 to March 1st 2020 to measure the frequency of sepsis-associated coagulopathy as well as its temporal relationship to critical illness in the NICU population. All clinical data in the electronic health record were extracted and deposited into an integrated data repository that was used for this work.ResultsWe identified 225 new sepsis episodes in 216 patients. An evaluation for sepsis-associated coagulopathy was performed in 96 (43%) episodes. Gram-negative pathogen, nSOFA score at evaluation, and mortality were greater among episodes that included a coagulopathy evaluation compared with those that did not. Abnormal coagulation results were common (271/339 evaluations; 80%) and were predominantly prothrombin times. Intervention (plasma or cryoprecipitate) followed a minority (84/271; 31%) of abnormal results, occurred in 40/96 (42%) episodes that were often associated with >1 intervention (29/40; 73%), and coincided with thrombocytopenia in 37/40 (93%) and platelet transfusion in 27/40 (68%). Shapley Additive Explanations modeling demonstrated strong predictive performance for the composite outcome of death and/or treatment for coagulopathy in neonates (f1 score 0.8, area under receiver operating characteristic curve 0.83 for those with abnormal coagulation values). The three most important features influencing the composite outcome of death or treatment for coagulopathy included administration of vasoactive medications, hematologic dysfunction assessed by the maximum nSOFA platelet score, and early sepsis (≤72 h after birth).ConclusionsA coagulopathy evaluation was performed in a minority of NICU patients with sepsis and was associated with greater illness severity and mortality. Abnormal results were common but infrequently associated with intervention, and intervention was contemporaneous with thrombocytopenia. The most important feature that influenced the composite outcome of death or treatment for coagulopathy was the administration of vasoactive-inotropic medications. These data help to identify NICU patients at risk of sepsis-associated coagulopathy.

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“…Eligible patients had a history of exposure to hot and humid weather or high-intensity activity, and they met at least one of the following criteria based on the Chinese Expert Consensus on the Diagnosis and Treatment of Heatstroke ( 1 ): (1) neurological dysfunction, including coma, convulsions, delirium, or abnormal behavior; (2) core temperature ≥ 40°C; (3) functional impairment of at least two organs; or (4) severe coagulopathy or DIC. Severe coagulopathy was defined as the presence of at least two of the following criteria: platelet count < 100,000 cells per μL, international normalized ratio > 1.5, fibrinogen level < 1.50 g/L, and D-dimer value above 10 times the upper limit of normal ( 11 ). Patients were excluded if they were younger than 18 years, if they had a congenital coagulopathy or severe chronic disease of the liver or kidney, or if they were using anticoagulant drugs at admission.…”

Section: Methodsmentioning

confidence: 99%

Nomogram for predicting disseminated intravascular coagulation in heatstroke patients: A 10 years retrospective study

Zeng

Zhong²,

Zhang

et al. 2023

Front. Med.

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BackgroundDisseminated intravascular coagulation (DIC) can lead to multiple organ failure and death in patients with heatstroke. This study aimed to identify independent risk factors of DIC and construct a predictive model for clinical application.MethodsThis retrospective study included 87 patients with heatstroke who were treated in the intensive care unit of our hospital from May 2012 to October 2022. Patients were divided into those with DIC (n = 23) or without DIC (n = 64). Clinical and hematological factors associated with DIC were identified using a random forest model, least absolute shrinkage and selection operator (LASSO) regression and support vector machine-recursive feature elimination (SVM-RFE). Overlapping factors were used to develop a nomogram model, which was diagnostically validated. Survival at 30 days after admission was compared between patients with or without DIC using Kaplan-Meier analysis.ResultsRandom forest, LASSO, and SVM-RFE identified a low maximum amplitude, decreased albumin level, high creatinine level, increased total bilirubin, and aspartate transaminase (AST) level as risk factors for DIC. Principal component analysis confirmed that these independent variables differentiated between patients who experienced DIC or not, so they were used to construct a nomogram. The nomogram showed good predictive power, with an area under the receiver operating characteristic curve of 0.976 (95% CI 0.948–1.000) and 0.971 (95% CI, 0.914–0.989) in the internal validation. Decision curve analysis indicated clinical utility for the nomogram. DIC was associated with significantly lower 30 days survival for heatstroke patients.ConclusionA nomogram incorporating coagulation-related risk factors can predict DIC in patients with heatstroke and may be useful in clinical decision-making.

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Coagulation Dysfunction Criteria in Critically Ill Children: The PODIUM Consensus Conference

Cited by 5 publications

References 29 publications

Elevated plasma D-dimer levels are associated with the poor prognosis of critically ill children

Elevated plasma D-dimer levels are associated with the poor prognosis of critically ill children

The frequency and timing of sepsis-associated coagulopathy in the neonatal intensive care unit

Nomogram for predicting disseminated intravascular coagulation in heatstroke patients: A 10 years retrospective study

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