AGE-RELATED DIFFERENCES IN OUTCOME AND SEVERITY OF DIC IN CHILDREN WITH SEPTIC SHOCK AND PURPURA

We studied the influence of age on mortality and severity of clotting abnormalities in 79 children (median age: 3.1 years) with meningococca l sepsis. Parameters of coagulation and fibrinolysis and plasma levels of cytokines were prospectively measured on admission. The mortality rate was 27%. The age of survivors was significantly different from th at of non-survivors (p = 0.013). With the exception of FVII, vWF and t -PA, parameters of coagulation and fibrinolysis, as well as plasma cyt okine levels were related to outcome. Patients were divided in two gro ups: younger and older than median age. The mortality in children less than or equal to 3.1 years was 40% versus 13% in children >3.1 years (p = 0.006). In contrast to cytokine levels, which were not different between the two age groups, fibrinogen, prothrombin, factors V, VII, V III, VWF, protein C, antithrombin, FDP, and the ratio PAI-lh-PA were r elated to age, indicating a more severe coagulopathy in children less than or equal to 3.1 years despite a similar degree of inflammatory re sponse. A relative deficiency of coagulation factors due to an immatur e state of the clotting system, as well as an inadequate fibrinolytic response, both related to age may have caused this more severe coagula tive response in younger children, and may have contributed to the hig her mortality rate.