Low levels of activated protein C in plasma - a predictor of death in low birth weight newborns with sepsis
In a cohort study, it was found that with an increase in the level of activated protein C in the plasma of 1%, the risk of death of newborns with sepsis born with low body weight decreases by 5%.
In a cohort study in India, a relationship was found between a decrease in the plasma concentration of activated protein C (endogenous anticoagulant) and an increase in mortality in infants with sepsis born with low body weight. the birth.
Activation of coagulation plays an important role in the pathogenesis of organ damage during sepsis, while endogenous anticoagulants suppress the cascading chain of coagulation reactions, resulting in tissue damage. In addition, with sepsis, the level of activated protein C in the blood plasma decreases.
In the above cohort study, the role of activated protein C in predicting the development of a fatal outcome in infants with sepsis born with low body weight was studied. The study involved infants with low birth weight sepsis with organ or multiple organ failure and systemic inflammatory response syndrome. A prerequisite was parental consent to the child's participation in the study. Activated plasma protein C levels were determined at baseline and 14 days after their inclusion in the study. The study did not include children born with low body weight who have severe birth defects and developmental abnormalities, severe asphyxia, or receiving blood preparations before determining the level of activated protein C in the plasma.
The study included 40 healthy born babies with low body weight, who were later diagnosed with severe bacterial sepsis, out of 74 children screened. Twenty-five newborns died within the first 2 weeks. The level of activated protein C in the blood plasma of deceased children was lower than that of survivors (average concentration (interquartile range), 15% (4.5-21%) vs 33% (18- 55%); p less than 0.001). With low levels of activated protein C, 10 children died and one child survived (p = 0.03). However, with an activated protein C concentration greater than 35%, only one newborn survived, as well as at a level less than 10%.
The mean survival period of the children in the group (n = 11) with a low concentration of activated protein C was lower than that of the group with its normal level (3 days (2.3-3.7) vs 10, p less than 0.001, 95% CI).
Insufficiency of multiple organs (mainly the cardiovascular and urinary systems) was more pronounced in newborns with a protein C level of less than 10%.
Following analysis of the data, the researchers found that with an increase in the level of activated protein C in the plasma of 1%, the risk of death decreases by 5%, however, this important prognostic indicator of survival of neonates with sepsis cannot be taken into account if the level of activated protein C in the plasma is low in the event of multiple organ failure and the consequences of these changes.