title: Diagnostic efficacy of activated partial thromboplastin time waveform and procalcitonin analysis in pediatric meningococcal sepsis.
abstract: OBJECTIVE
  A biphasic activated partial thromboplastin time waveform predicts sepsis and disseminated intravascular coagulation in adults. This has not been previously investigated in children. Our aim is to ascertain whether there are changes in the activated partial thromboplastin time waveform in children with meningococcal disease and to compare its diagnostic use with procalcitonin.
  
  
  METHODS
  Alder Hey Children's National Health Service Foundation Trust, Liverpool, UK.
  
  
  METHODS
  Thirty-six children admitted to the hospital for the treatment of suspected meningococcal disease had activated partial thromboplastin time waveform and procalcitonin analysis performed at admission. The light transmittance level at 18 secs was used to quantitate the waveform. Severity of disease was assessed using the Glasgow Meningococcal Septicaemia Prognostic Score, Pediatric Risk of Mortality III score, and the Pediatric Logistic Organ Dysfunction score.
  
  
  RESULTS
  Twenty-four children had proven meningococcal disease, 12 had a presumed viral illness, and 20 control subjects were recruited. Transmittance level at 18 secs was lower in children with meningococcal disease and those with a viral illness (p < .0001) and control subjects (p < .0005). Sensitivity and specificity was 0.91 and 0.96 for transmittance level at 18 secs and 0.92 and 1 for procalcitonin in identifying meningococcal disease. There was a significant difference in procalcitonin between children with meningococcal disease and those with a viral illness and control subjects (p < .0005). A negative correlation was found between transmittance level at 18 secs and length of hospital stay (p < .0001), C-reactive protein (p < .0001), procalcitonin (p < .0001), Glasgow Meningococcal Septicaemia Prognostic Score (p < .01), Pediatric Risk of Mortality III score (p < .0001), and Pediatric Logistic Organ Dysfunction score score (p < .0001).
  
  
  CONCLUSIONS
  The activated partial thromboplastin time waveform is abnormal in children with meningococcal disease and may be a useful adjunct in the diagnosis and management of sepsis in children.
authors.affiliation: Institute of Child Health, University of Liverpool, Alder Hey Children's National Health Service Foundation Trust, Liverpool, UK. fauziapaize@msn.com
authors.forename: Fauzia
authors.initials: F
authors.lastname: Paize
authors.forename: Enitan
authors.initials: E
authors.lastname: Carrol
authors.forename: Colin
authors.initials: C
authors.lastname: Downey
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Parry
authors.forename: Gerwyn
authors.initials: G
authors.lastname: Green
authors.forename: Peter
authors.initials: P
authors.lastname: Diggle
authors.forename: Paul
authors.initials: P
authors.lastname: Newland
authors.forename: F A I
authors.initials: FA
authors.lastname: Riordan
authors.forename: Alistair
authors.initials: A
authors.lastname: Thomson
authors.forename: C A
authors.initials: CA
authors.lastname: Hart
authors.forename: Cheng-Hock
authors.initials: CH
authors.lastname: Toh
mesh_terms: D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D002675:Child, Preschool; D004739:England; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D008589:Meningococcal Infections / Q000175:diagnosis*; D009345:Neisseria meningitidis / Q000302:isolation & purification; D010314:Partial Thromboplastin Time; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D018805:Sepsis / Q000175:diagnosis*
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide