YOĞUN BAKIMA YATAN HASTALARDA ATIII SEVİYESİ VE PROGNOSTİK DEĞERİ

Abstract

Amaç: Antitrombin 3’ün yo÷un bakıma yatan hastalardaki prognostik de÷erini araútırmak.
Gereç ve yöntem: Çalıúmamızda yo÷un bakıma yatan 215 hasta dahil edildi. Hastalar 1-16 yaú arasındaydı, 90’ı kız 125’i erkekti.
Bulgular: Antitrombin III aktivitesindeki azalma prognozla yakın iliúkili görülmektedir.
Sonuç: Bizim çalıúmamızda vardı÷ımız sonuç gibi Antitrombin III aktivitesindeki azalma prognozla yakın iliúkili görülmektedir.
Özellikle aktivitenin %50 nin altına inmesi güçlü bir prognostik gösterge olarak kabul edilmektedir.  

Keywords

• Çocuk yo un bakım
• Antitrombin III seviyesi
• prognostik de er

AT-III LEVEL AND ITS PROGNOSTIC SIGNIFICANCE IN PATIENTS IN PEDIATRIC INTENSIVE CARE UNIT

Abstract

Aim: Our objective is to investigate the prognostic value of Antithrombin III in our intensive care.
Gereç ve yöntem: 215 patients admitted to intensive care were included. The age of patients were between 1-16 years, 125 were
male, and 90 female.
Results: Prognosis is related to the decrease in antithrombin III activity.
Conclusion: Our study showed that the decrease in antithrombin III activity is closely related to prognosis. Particular activity to
below 50% is considered a powerful prognostic indicator. 

Keywords

• Pediatric intensive care unit
• AT III level
• prognostic significance

References

1. Schnitzel H, Weilemann L S. Antithrombin substitution therapy. Blood Coag Fibrinol 1998; 9 (suppl 3): 17-22.
2. Pratt CW, Church FC. Antithrombin structure and function. Semin Hematol 1991; 28: 3-9.
3. Van’t Veer C, Mann KG. Regulation of tissue factor initiated thrombin generation by the stoichiometric inhibitors tissue factor pathway inhibitor,
4. antithrombin III and heparin cofactor II. J Biol Chem 1997; 14: 4367-4377.
5. Pizzo SV, Durham Ph D. Serpin receptor 1: hepatic receptor that mediates the clearance of antithrombin III-proteinase complexes. Am J Med
6. ; 87 (suppl 3B): 10-14.
7. Mammen EF. Antithrombin :Its physiological importance and role in D
8. Eisele B, Lamy M. Clinical experience with antithrombin III concentrates in critically ill patients with sepsis and multiple organ failure. Semin

9. Thromb Hemost 1998; 24(1):71-80.
10. Nielsen JD. The effect of antithrombin on systemic inflammatory response in disseminated intravascular coagulation. Blood Coag Fibrinol 1998;
11. (suppl 3): 11-15.
12. Davie E, Ratnoff O D. Waterfall sequence for intrinsic blood clotting. Science 1964; 145: 1310-1312.
13. Vinazzer H. Clinical use’s of ATIII. Von Sang 1987; 53: 193-198.
14. Mamnen EF. Antithrombin: Its physiological importance and role in DIC. Semin Thromb Hemost 1998; 24: 19-25.
15. Tahtacı N, Elmacıo
16. Niessen RWL, Lamping RJ, Jonsen PM, et. al. Antithrombin acts as a negative acute phase protein as established with studies on Hep G2 cells
17. and in baboons. Thromb Haemost 1997; 78:1088-1092.
18. Mammen EF, Balk R, Emerson T Jr, et. al. Therapeutic use of antithrombin concentrates in sepsis. Semin Thromb Hemost 1998; 24: 183-194.
19. Dickneite G. Antithrombin III in animal models of sepsis and organ failure. Semin Thromb Hemost 1998; 24: 61-69.
20. Warren BL, Eid A, Singer P, et. al. High dose antithrombin III in severe sepsis. A randomized controlled trial. JAMA 2001; 286: 1869-1878.
21. Olcay L, Gürgey A. Herediter trombotik hastalıklar. Katkı Pediatri Derg 1995; 6:887-907.
22. Casgriff JM, Bishop DT, Hersfold EJ, Skolnick MH, et. al. Hereditary antithrombin deficiency diagnosis and treatment. Medicine 1983; 62: 4.
23. Wilson C, Walker ID, Davidson JF. Mesenteric venous thrombosis and ATIII deficiency. J Clin Pathol 1987; 40: 906-908.
24. Lee MK. Cerebral Venous Thrombosis with ATIII deficiency. Aust NZ J Med 1991;21.
25. Levi M, Ten Cate H, Van der Poll T, Van Deventer SJH. Pathogenesis of disseminated intravascular coagulation in sepsis. JAMA 1993; 270: 975-
26. -
27. Vervloet MG, Thijs LG, Hack CE. Derangement’s of coagulation and fibrinolysis in critically ill patients with sepsis and septic shock. Semin Thromb
28. Hemostas 1998; 24: 33-44.
29. Mesters RM, Mannucci PM, Coppola R, Keller T, Ostermann H, Kienast J. Factor VIIa and antithrombin III activity during severe sepsis and septic
30. shock in neutropenic patients. Blood 1996; 88: 881-886.
31. Hellgren M, Javelin L, Hagnevik K, et. al. Antithrombin III concentrate as adjuvant in DIC treatment- a pilot study in 9 severely ill patients. Thromb
32. Res 1984; 36:459-466.
33. Blauhut B, Kramar H, Vinazzer H, et. al. Substitution of antithrombin III in shock and DIC: A randomised study. Thromb Res 1985; 29:81-89.
34. Montgomery RR, Scott JP. Hemorrhagic and thrombotic disease. Behrman Nelson Texbook Pediatrics 17th edition 2004; 1651-1656.
35. Nesheim ME. A simple rate low that describes the kinetics of the heparin catalysed reaction between antithrombin III and trombin. J Biol Chem
36. ; 23(14): 708.
37. Van der Poll T, van Deventer SJH. Cytokines and anticytokines in the pathogenesis of sepsis. Infect Dis Clin North Am 1999; 13: 413-426.
38. Bone RC. Modulators of coagulation. A critical appraisal of their role in sepsis. Arch Intern Med 1992; 152: 1381-1389.
39. Bone RC. Sepsis and coagulation. Ann Important Link. Chest 1992; 101 (3): 594-595.
40. Heyderman RS. Sepsis and intravascular thrombosis. Arch Dis Child 1993; 68: 621-625.
41. Fourrier F, Chopin C, Goudemand J, Hendryx S, Caron C, Rime A, et. al. Septic shock, multiple organ failure and disseminated intravascular
42. coagulation. Compared patterns of antithrombin III, protein C and protein S deficiencies. Chest 1992; 101: 816-823.
43. Mammen EF. The haematological manifestations of sepsis. J Antimicrob Chemother 1998; 41 (Suppl A): 17-24.
44. Levi M, ten Cate H, Disseminated intravascular coagulation. N Engl J Med 1999; 341: 586-592.
45. Bick RL. Disseminated intravascular coagulation: pathophysiological mechanisms and manifestations. Semin Thromb Hemostas 1998; 24: 3-18.
46. Blanco A, Guisasola JA, Solis P, Bachiller R, Gonzalez H. Fibronectin in meningococcal sepsis. Correlation with antithrombin III and protein C.
47. Acta Pediatr Scand 1990; 79: 73-76.
48. Fourrier F, Lestavel P, Chopin C, Marey A, Goudemand J, Rime A, et. al. Meningococcemia and purpura fulminans in adults: acute deficiencies of
49. protein C and protein S and early treatment with antithrombin III concentrates. Intensive Care Med 1990; 16: 121-124.
50. Sanchez MA, at al. Abnormalities in coagulation and fibrinolysis in septic shock with purpura. An Esp Pediatr 2002; 56(2): 99-103.
51. Dschietzig T, et.al. Stimulation of pulmonary big endothelin-1 and endothelin-1 by antithrombin III: a rationale for combined application of
52. antithrombin III and endothelin antagonist in sepsis-related acute respiratory distres syndrome? Crit Care Med. 2000 Jul; 28(7): 2445-9.
53. Uchiba M, Okajima K. Antithrombin III prevents LPS-induced vascular injury: Novel biological activity of ATIII. Thromb Haemostas 1997; 23: 583-
54. -
55. Sundar S, Mall RK, Dube B, Singh VP. Antithrombin III in liver disorders. J Assoc Physicians India. 1991; 39(7): 522-4.
56. Pettila V, Pentti J, Pettila M, Takkunen O, Jousela I. Predictive value of antithrombin III and serum C-reactive protein concentration in critically ill
57. patients with suspected sepsis. Crit Care Med 2002; 30(2): 271-5.