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Vol. 56. Issue 2.
Pages 99-103 (1 February 2002)
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Vol. 56. Issue 2.
Pages 99-103 (1 February 2002)
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Alteraciones del sistema de la coagulación y la fibrinólisis en el shock séptico asociado a púrpura
Abnormalities in coagulation and fibrinolysis in septic shock with purpura
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A. Sánchez Mirallesa, R. Reig Sáenza,
Corresponding author
reig_rob@gva.es

Correspondencia: Unidad de Cuidados Intensivos. Hospital General Universitario de Alicante. Maestro Alonso, 109. 03010 Alicante.
, P. Marco Verab, F. Muñoz Péreza, B. Álvarez Sáncheza, I. Sebastián Muñoza
a Unidad de Cuidados Intensivos Pediátricos. Servicio de Medicina Intensiva
b Servicio de Hematología. Hospital General Universitario de Alicante
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Objetivos

Describir las alteraciones en el sistema de la coagulación y la fibrinólisis en el shock séptico asociado a púrpura y analizar la relación entre concentración plasmática de inhibidor del activador del plasminógeno tipo 1 (PAI-1) y la presencia de fracaso multiorgánico (FMO).

Métodos

Estudio observacional en la Unidad de Cuidados Intensivos Pediátricos (UCIP) de un hospital universitario de tercer nivel. Se analizó en 15 niños ingresados de forma consecutiva con shock séptico y púrpura la presencia de FMO en el momento del ingreso. Se obtuvieron muestras sanguíneas para estudiar los parámetros del sistema de coagulación y la fibrinólisis.

Resultados

En el momento del ingreso 7 pacientes (46,7 %) presentaban FMO; 6 pacientes (40 %), síndrome de distrés respiratorio agudo (SDRA); 7 pacientes (46,7 %), coagulopatía de consumo, y 1 paciente (6,7 %), fracaso renal agudo. La mortalidad observada fue de 40 %. Los parámetros del sistema de la coagulación analizados estaban en general alterados, aunque sólo se observaron diferencias estadísticamente significativas en las concentraciones plasmáticas de fibrinógeno y antitrombina III que fueron menores en el grupo con FMO que en los pacientes sin disfunción de órganos. Los parámetros de la fibrinólisis estaban aumentados en todos los pacientes pero sólo se observaron concentraciones plasmáticas de PAI-1 significativamente elevadas en el grupo con FMO y en aquellos con SDRA.

Conclusiones

Los resultados sugieren que las alteraciones del sistema fibrinolítico pueden tener un papel importante en el desarrollo de FMO en niños con shock séptico y púrpura.

Palabras clave:
Shock séptico
Fracaso multiorgánico
Síndrome de distrés respiratorio agudo
Coagulación intravascular diseminada
Púrpura
Inhibidor del activador del plasminógeno tipo 1
Niños
Objective

To describe abnormalities in coagulation and fibrinolysis in septic shock with purpura and to assess the relationship between plasma plasminogen activator inhibitor-1 (PAI-1) concentrations and multiple organ system failure (MOSF).

Methods

Observational study in the pediatric intensive care unit of a tertiary care hospital. The presence of early MOSF was assessed at admission in 15 children with septic shock and purpura consecutively admitted to the pediatric intensive care unit. Blood samples were taken to determine coagulation and fibrinolysis parameters.

Results

At admission, MOSF was diagnosed in 7 patients (46.7%), acute respiratory distress syndrome (ARDS) in 6 (40 %), consumption coagulopathy in 7 (46.7 %) and acute renal failure in 1 (6.7 %). The overall mortality rate was 40 %. Coagulation parameters were generally affected but statistically significant differences were found only in concentrations of fibrinogen and antithrombin III, which were lower in patients with MOSF than in those without organ dysfunction. Fibrinolysis parameters were increased in all patients but plasma PAI-1 concentrations were significantly elevated only in patients with MOSF and in those with ARDS.

Conclusions

These data indicate that impaired fibrinolysis could play a major role in the development of MOSF in children with septic shock and purpura.

Key words:
Septic shock
Multiple organ system failure
Acute respiratory distress syndrome
Intravascular coagulation
Purpura
Plasminogen activator inhibitor type 1
Children
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