[Abnormalities in coagulation and fibrinolysis in septic shock with purpura].
OBJECTIVE
To describe abnormalities in coagulation and fibrinolysis in septic shock with purpura and to assess the relationship between plasma plasminogen activator inhibitor-1 (PAI-1) concentrations and multiple organ system failure (MOSF).


METHODS
Observational study in the pediatric intensive care unit of a tertiary care hospital. The presence of early MOSF was assessed at admission in 15 children with septic shock and purpura consecutively admitted to the pediatric intensive care unit. Blood samples were taken to determine coagulation and fibrinolysis parameters.


RESULTS
At admission, MOSF was diagnosed in 7 patients (46.7 %), acute respiratory distress syndrome (ARDS) in 6 (40 %), consumption coagulopathy in 7 (46.7 %) and acute renal failure in 1 (6.7 %). The overall mortality rate was 40 %. Coagulation parameters were generally affected but statistically significant differences were found only in concentrations of fibrinogen and antithrombin III, which were lower in patients with MOSF than in those without organ dysfunction. Fibrinolysis parameters were increased in all patients but plasma PAI-1 concentrations were significantly elevated only in patients with MOSF and in those with ARDS.


CONCLUSIONS
These data indicate that impaired fibrinolysis could play a major role in the development of MOSF in children with septic shock and purpura.
Sánchez Miralles
A
A
Unidad de Cuidados Intensivos Pediátricos, Servicio de Medicina Intensiva, Hospital General de Alicante, Spain.
Reig Sáenz
R
R
Marco Vera
P
P
Muñoz Pérez
F
F
Alvarez Sánchez
B
B
Sebastián Muñoz
I
I
D001777:Blood Coagulation; D002648:Child; D002675:Child, Preschool; D005260:Female; D005342:Fibrinolysis; D006801:Humans; D007223:Infant; D008297:Male; D009102:Multiple Organ Failure / Q000097:blood / Q000209:etiology*; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood; D011693:Purpura / Q000097:blood / Q000209:etiology*; D012772:Shock, Septic / Q000097:blood / Q000150:complications*
D017395:Plasminogen Activator Inhibitor 1