title: Factor VIII May Predict Catheter-Related Thrombosis in Critically Ill Children: A Preliminary Study.
abstract: OBJECTIVE
  If we can identify critically ill children at high risk for central venous catheter-related thrombosis, then we could target them for pharmacologic thromboprophylaxis. We determined whether factor VIII activity or G value was associated with catheter-related thrombosis in critically ill children.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Two tertiary academic centers.
  
  
  METHODS
  We enrolled children younger than 18 years who were admitted to the PICU within 24 hours after insertion of a central venous catheter. We excluded children with a recently diagnosed thrombotic event or those anticipated to receive anticoagulation. Children with thrombosis diagnosed with surveillance ultrasonography on the day of enrollment were classified as having prevalent thrombosis. Those who developed catheter-related thrombosis thereafter were classified as having incident thrombosis.
  
  
  METHODS
  None.
  
  
  RESULTS
  We enrolled 85 children in the study. Once enrolled, we measured factor VIII activity with one-stage clotting assay and determined G value with thromboelastography. Of those enrolled, 25 had incident and 12 had prevalent thromboses. The odds ratio for incident thrombosis per SD increase in factor VIII activity was 1.98 (95% CI, 1.10-3.55). The area under the receiver operating characteristic curve was 0.66 (95% CI, 0.52-0.79). At factor VIII activity more than 100 IU/dL, which was the optimal threshold identified using Youden index, sensitivity and specificity were 92.0% and 41.3%, respectively. The association between factor VIII activity and incident thrombosis remained significant after adjusting for important clinical predictors of thrombosis (odds ratio, 1.93; 95% CI, 1.10-3.39). G value was associated with prevalent but not with incident thrombosis.
  
  
  CONCLUSIONS
  Factor VIII activity may be used to stratify critically ill children based on their risk for catheter-related thrombosis.
authors.affiliation: 1Department of Pediatrics, Yale School of Medicine, New Haven, CT. 2Pediatric Intensive Care Unit, Maria Fareri Children's Hospital, Valhalla, NY. 3Department of Diagnostic Radiology, Yale School of Medicine, New Haven, CT. 4Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT. 5Pediatric Intensive Care Unit, Yale-New Haven Hospital, New Haven, CT. 6Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT. 7Department of Internal Medicine, Yale School of Medicine, New Haven, CT. 8Department and of Pathology, Yale School of Medicine, New Haven, CT. 9Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT. 10Department of Investigative Medicine, Yale Graduate School of Arts and Sciences, New Haven, CT.
authors.forename: Edward Vincent S
authors.initials: EV
authors.lastname: Faustino
authors.forename: Simon
authors.initials: S
authors.lastname: Li
authors.forename: Cicero T
authors.initials: CT
authors.lastname: Silva
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Pinto
authors.forename: Li
authors.initials: L
authors.lastname: Qin
authors.forename: Joana A
authors.initials: JA
authors.lastname: Tala
authors.forename: Henry M
authors.initials: HM
authors.lastname: Rinder
authors.forename: Gary M
authors.initials: GM
authors.lastname: Kupfer
authors.forename: Eugene D
authors.initials: ED
authors.lastname: Shapiro
mesh_terms: D000293:Adolescent; D019540:Area Under Curve; D002408:Catheters, Indwelling / Q000009:adverse effects; D062905:Central Venous Catheters / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D005169:Factor VIII / Q000378:metabolism*; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D013916:Thrombelastography; D020246:Venous Thrombosis / Q000097:blood* / Q000209:etiology* / Q000517:prevention & control
chemical_list: D005169:Factor VIII
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