الفهرس 
Pediatric sepsisOnly 14 pages are availabe for public view
 |  | from | 114 |  |  |
| | | from | 114 | | |
Abstract
Sepsis is a life-threatening organ dysfunction caused by a deleterious host response to infection. It is a leading cause of morbidity and mortality in critically ill pediatric patients. More than 20000 children are affected by severe sepsis annually in the United States, with mortality estimates ranging from 4.2% to10.3%.
The mortality rate of SIRS, sepsis, severe sepsis and septic shock is high, ranging from approximately 10% in SIRS to 60% in septic shock. While identification and treatment of sepsis has led to a decrease in mortality, the incidence continues to increase resulting in a still larger number of deaths annually. Worldwide, sepsis is thus the major cause of death in intensive care units (ICU) and therefore an area of concern.
In order to improve the survival of patients with SIRS and sepsis, it is essential to identify the individuals at high risk. One approach for this identification is constantly evaluating reliable biological markers. Diagnostic markers should be able to accurately detect the disease early in its course while prognostic markers must predict the progression of the disease.
Biomarkers play a pivotal pole in early diagnosis, differential diagnosis, risk stratification, therapy monitoring and evaluation of prognosis of sepsis. Thrombomodulin (TM), CD141 or BDCA-3 is an integral membrane protein expressed on the surface of endothelial cells and serves as a cofactor for thrombin is a novel biomarker that has been used for diagnosis of sepsis in recent years, and its production is related to damaged vascular endothelial cells led us to hypothesize that plasma levels of soluble TM could be an indicator of the development of organ failure.
Thrombomodulin has a pivotal role in the protein C system that is important in the pathogenesis of sepsis. In sepsis, endothelial cell expression of thrombomodulin is strongly downregulated, causing an impaired activation of protein C that is central in the modulation of coagulation activation and inflammatory processes. In addition, thrombomodulin itself has marked immunomodulatory effects, targeting neutrophil adhesion, complement activation and cytokine generation.
Our aim in this study was to assess reliability of thrombomodulin as a diagnostic and prognostic value for sepsis in pediatric intensive care unit of Menoufia University.
To achieve this target, This study was carried on 70 patients of proven /suspected sepsis who met the inclusion criteria (patients group), 38 were males and 32 were females, their age ranged from 1.5 to 192 months and 25 healthy children with age and sex matched to the first group, considered as a (control group) 11 were males and 14 were females, their age ranged from 1.9 to 193 months. This study done at Pediatric Intensive Care Unit of Menoufia University, in the period from Octobar 2018 to Septemper 2019.All children incorporated in the study were subjected to: careful history taking, thorough clinical examination and laboratory investigations. PRISM score was calculated within 24hrs of admission for each patient, using the 14th measured clinical and laboratory variables. Data were entered on the website http://www.sfar.org/scores2/prism2.php. Inserting the patient’s age in months in the specified window led to automatic calculation of the predicted death rate.