[Significance of soluble P-selectin in diagnosis of pre-disseminated intravascular coagulation state in children with severe pneumonia].

Objective: Inflammation and coagulation occur concomitantly in severe pneumonia. The term non-overt disseminated intravascular coagulation (DIC) (pre-DIC state) refers to a state prevalent before the occurrence of overt DIC. It is suggested that initiation of treatment in non-overt DIC leads to better outcome than in overt DIC. The present study aimed at evaluating potential use of soluble P-selectin in diagnosis of pre-DIC state of children with severe pneumonia.

Method: The laboratory findings (including soluble P-selectin, D-Dimer, platelet count, activated partial prothrombin time, prothrombin time and fibrinogen) of 226 children with severe pneumonia from Jan. 2010 to Jul. 2011 in pediatric intensive care unit (PICU), were analyzed in this prospective cohort study, and the ROC curve was plotted to evaluate the potential role of soluble P-selectin in diagnosis of pre-DIC state.

Result: A total of 226 patients with severe pneumonia comprised of 75 positive and 151 negative pre-DIC state cases were enrolled. The mean value of soluble P-selectin, D-Dimer, and platelet count were 124.8 (26.9 - 608.3) µg/L, 1.3(0.7 - 16.0) mg/L and 91 (56 - 196)×10(9) for the positive cases, and 63.3 (2.8 - 302.1) µg/L, 0.5 (0.2 - 1.0) mg/L and 231 (120 - 680)×10(9) for the negative cases, respectively. There was a significant difference between the two groups. Coagulatory function in the positive cases, including activated partial prothrombin time, prothrombin time and fibrinogen which were (39.1 ± 3.5) sec, (14.8 ± 2.1) sec and (3.8 ± 0.5) g/L, respectively, were significantly higher than those in the negative cases [(37.2 ± 2.4) sec, (13.0 ± 0.5) sec and (3.3 ± 0.2) g/L] (P < 0.001). The area under ROC curve showed that D-dimer, soluble P-selectin for pre-DIC state had higher diagnostic value. The Optimal Operating Point of soluble P-selectin was determined and interpreted at 94.0 µg/L with a sensitivity of 0.824, a specificity of 0.887, and the Optimal Operating Point of D-dimer was determined and interpreted at 0.7 mg/L with a sensitivity of 0.905, a specificity of 0.867, systematic test of soluble P-selectin and D-dimer had a higher specificity of 0.920, determined at the same time.

Conclusion: To improve the outcome of patients with DIC, there is a need to establish more useful and easily operative diagnostic criteria for pre-DIC state. Plasma levels of soluble P-selectin will be helpful in this respect. Systematic test of soluble P-selectin and D-dimer may be helpful in reducing misdiagnosis rate.