دورية أكاديمية
أعرض في EDS

Elevated soluble thrombomodulin is associated with organ failure and mortality in children with acute respiratory distress syndrome (ARDS): a prospective observational cohort study.

التفاصيل البيبلوغرافية
العنوان: Elevated soluble thrombomodulin is associated with organ failure and mortality in children with acute respiratory distress syndrome (ARDS): a prospective observational cohort study.
المؤلفون: Orwoll BE; Department of Pediatrics, Division of Critical Care, University of California, San Francisco Benioff Children's Hospital, 550 16th St, Box 0106, San Francisco, CA, 94143, USA. orwoll@ucsf.edu.; Division of Pediatric Critical Care, University of California, San Francisco Benioff Children's Hospital, 747 52nd St., Oakland, 94609, CA, USA. orwoll@ucsf.edu., Spicer AC; Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit St., Boston, 02114, MA, USA. aspicer@partners.org., Zinter MS; Department of Pediatrics, Division of Critical Care, University of California, San Francisco Benioff Children's Hospital, 550 16th St, Box 0106, San Francisco, CA, 94143, USA. Matt.Zinter@ucsf.edu.; Division of Pediatric Critical Care, University of California, San Francisco Benioff Children's Hospital, 747 52nd St., Oakland, 94609, CA, USA. Matt.Zinter@ucsf.edu., Alkhouli MF; Department of Pediatrics, Division of Critical Care, University of California, San Francisco Benioff Children's Hospital, 550 16th St, Box 0106, San Francisco, CA, 94143, USA. Mustafa.Alkhouli@ucsf.edu., Khemani RG; Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, 4650 Sunset Blvd., Los Angeles, 90027, CA, USA. RKhemani@chla.usc.edu., Flori HR; Division of Pediatric Critical Care, University of California, San Francisco Benioff Children's Hospital, 747 52nd St., Oakland, 94609, CA, USA. hflori@mail.cho.org., Neuhaus JM; Department of Epidemiology and Biostatistics, University of California, San Francisco School of Medicine, 550 16th St., San Francisco, 94158, CA, USA. John.Neuhaus@ucsf.edu., Calfee CS; Departments of Medicine and Anesthesia, Cardiovascular Research Institute, University of California, San Francisco, 555 Mission Bay Blvd. South, San Francisco, 94158, CA, USA. Carolyn.Calfee@ucsf.edu., Matthay MA; Departments of Medicine and Anesthesia, Cardiovascular Research Institute, University of California, San Francisco, 555 Mission Bay Blvd. South, San Francisco, 94158, CA, USA. MatthayM@anesthesia.ucsf.edu., Sapru A; Department of Pediatrics, Division of Critical Care, University of California, San Francisco Benioff Children's Hospital, 550 16th St, Box 0106, San Francisco, CA, 94143, USA. Anil.Sapru@ucsf.edu.
المصدر: Critical care (London, England) [Crit Care] 2015 Dec 14; Vol. 19, pp. 435. Date of Electronic Publication: 2015 Dec 14.
نوع المنشور: Journal Article; Multicenter Study; Observational Study; Research Support, N.I.H., Extramural
اللغة: English
بيانات الدورية: Publisher: BioMed Central Ltd Country of Publication: England NLM ID: 9801902 Publication Model: Electronic Cited Medium: Internet ISSN: 1466-609X (Electronic) Linking ISSN: 13648535 NLM ISO Abbreviation: Crit Care Subsets: MEDLINE
أسماء مطبوعة: Publication: London, UK : BioMed Central Ltd
Original Publication: London : Current Science Ltd, c1997-
مواضيع طبية MeSH: Lung/*metabolism , Lung Injury/*complications , Multiple Organ Failure/*etiology , Respiratory Distress Syndrome/*mortality , Thrombomodulin/*blood, Child ; Child, Preschool ; Cohort Studies ; Endothelium, Vascular/metabolism ; Endothelium, Vascular/pathology ; Female ; Humans ; Lung/physiopathology ; Lung Injury/metabolism ; Lung Injury/physiopathology ; Male ; Multiple Organ Failure/mortality ; Multiple Organ Failure/physiopathology ; Prognosis ; Prospective Studies ; Respiratory Distress Syndrome/blood ; Respiratory Distress Syndrome/etiology ; Respiratory Distress Syndrome/physiopathology ; Thrombomodulin/analysis ; Thrombomodulin/metabolism
مستخلص: Introduction: The significance of endothelial injury in children with the acute respiratory distress syndrome (ARDS) has not been well studied. Plasma levels of soluble thrombomodulin (sTM), an endothelial surface protein involved in coagulation, have been associated with endothelial injury. We hypothesized that elevated plasma sTM would correlate with mortality and organ failure in children with ARDS.
Methods: We conducted a multicenter prospective observational study of pediatric patients with ARDS between 2008 and 2014. sTM was measured in plasma collected less than 24 hours from ARDS diagnosis. Outcomes were intensive care unit mortality and organ dysfunction by pediatric logistic organ dysfunction scores. Logistic regression was used to adjust for clinically relevant covariates.
Results: Plasma sTM was higher in patients with indirect lung injury compared to direct lung injury (100 ng/mL vs. 86 ng/mL, p = 0.02). Increased sTM levels were correlated with more organ dysfunction in the entire study population (Spearman's rho = 0.37, p < 0.01). Overall mortality was 16%. sTM levels were associated with increased mortality in patients with indirect lung injury (OR 2.7 per log(sTM), p = 0.02). These relationships were independent of age, oxygenation defect, or presence of acute kidney injury.
Conclusion: Elevated plasma sTM levels are associated with organ dysfunction in children with ARDS and with higher mortality in children with indirect lung injury. These findings highlight the importance of endothelial injury in children with ARDS and may guide the development of future therapies targeted toward endothelial stabilization, repair, or functional replacement in this population.
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معلومات مُعتمدة: K23 HL085526 United States HL NHLBI NIH HHS; R01 HL114484 United States HL NHLBI NIH HHS; R37 HL051856 United States HL NHLBI NIH HHS; NHLBI R37HL51856 United States PHS HHS; NHLBI HL114484 United States PHS HHS; NHLBI HL085526 United States PHS HHS
المشرفين على المادة: 0 (THBD protein, human)
0 (Thrombomodulin)
تواريخ الأحداث: Date Created: 20151215 Date Completed: 20160706 Latest Revision: 20201209
رمز التحديث: 20231215
مُعرف محوري في PubMed: PMC4699329
DOI: 10.1186/s13054-015-1145-9
PMID: 26652251
قاعدة البيانات: MEDLINE
الوصف
تدمد:1466-609X
DOI:10.1186/s13054-015-1145-9