title: Early elevation of plasma von Willebrand factor antigen in pediatric acute lung injury is associated with an increased risk of death and prolonged mechanical ventilation.
abstract: OBJECTIVE
  Von Willebrand factor antigen (vWF-Ag) is a marker of pulmonary and systemic endothelial activation and injury. Adult studies indicate that patients with plasma vWF-Ag levels > or = 450% of control early in the course of acute lung injury (ALI) have an increased risk of death. The objective of this study was to evaluate whether vWF-Ag is elevated in the early phase of ALI in children and whether the magnitude of the increase was predictive of two important outcomes: mortality or duration of mechanical ventilation.
  
  
  METHODS
  Two-center, prospective observational study.
  
  
  METHODS
  Two pediatric intensive care units: one in an academic university setting and one in a major community children's hospital.
  
  
  METHODS
  After appropriate consent, plasma was collected from 48 pediatric patients on day 1 of ALI, 45 patients on day 2 of ALI, and four intubated controls.
  
  
  METHODS
  None.
  
  
  RESULTS
  Mean PaO2/FiO2 at the onset of ALI was 140 +/- 70, and mortality rate was 17%. vWF-Ag levels on day 1 of ALI were higher in patients compared with controls (287 +/- 183 vs. 87 +/- 84% of control [mean +/- SD], p < .05). Patients with vWF-Ag levels > or = 450% of control on day 1 of ALI had a markedly greater risk of death (odds ratio, 7.0; confidence interval, 1.31, 37.30; p < .05). Multivariate analysis revealed that elevated vWF-Ag level and either presence of multiple organ system failure or Pediatric Risk of Mortality III score independently predict increased risk of death. vWF-Ag levels on day 2 of ALI were significantly higher in patients who required prolonged mechanical ventilation (316 +/- 173 vs. 191 +/- 89% of control, p < .05).
  
  
  CONCLUSIONS
  Early injury to the systemic and pulmonary endothelium, as measured by plasma vWF-Ag levels, is associated with an increased risk of death and prolonged mechanical ventilation in pediatric patients with ALI.
authors.affiliation: Children's Hospital and Research Center Oakland, Division of Pediatric Critical Care, 747 52nd Street, Oakland, CA 94609, USA. hflori@mail.cho.org
authors.forename: Heidi R
authors.initials: HR
authors.lastname: Flori
authors.forename: Lorraine B
authors.initials: LB
authors.lastname: Ware
authors.forename: Meredith
authors.initials: M
authors.lastname: Milet
authors.forename: Michael A
authors.initials: MA
authors.lastname: Matthay
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015278:Intensive Care Units, Pediatric; D016015:Logistic Models; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects*; D012128:Respiratory Distress Syndrome / Q000097:blood* / Q000401:mortality*; D012307:Risk Factors; D014841:von Willebrand Factor / Q000378:metabolism*
chemical_list: D014841:von Willebrand Factor