in children with septic shock and purpura

Abstract. Objective: To establish the relation between routine laboratory data (lactate, fibrinogen, CRP) and cytokines (TNF, I L- 1 and- 6) and to estimate their prog-nostic value in pediatric patients with severe infectious purpura on admission. Design: Prospective study. Setting. " Pediatric intensive care unit (PICU). Patients: 17 children aged 5-172 months (median 46) were hospitalized in our PICU in 1989-90 with severe in-fectious purpura. Neisseria meningitidis was isolated in 15 children and Haemophilus influenzae in two. The pa-tients were divided into 3 groups: non-shock, shock and severe shock leading to death. Shock was defined by stan-dard criteria. Measurements: Arterial blood was sampled for lactate, CRP, fibrinogen, TNF, and IL-1 and-6 on admission. The PRISM (pediatric risk of morality)-score was re-corded. Methods. " Statistical analysis was performed with the Stu-dent's t-test using the logarithmic values of the cytokine concentration, and Spearman correlation analysis. Results. " According to the shock criteria, 9 patients were in shock of whom 4 did not survive. Significant dif-ferences existed between the 3 groups concerning lactate, TNF, and IL-6. Fibrinogen, CRP, IL-1, and PRISM-score discriminated only between survivors and non-survivors. A highly significant correlation existed between cytokines, the PRISM-score and lactate (TNF: r = 0.69