More than 10% of children surviving septic shock with purpura have skin necrosis or limb ischaemia (SNLI.). Among 44 children
consecutively admitted to our pediatric intensive care unit, 35 (80%) survived, 6 of them (17%) developed SNLI (defined as
the need of a surgical procedure). Two timed haemostasis measurements included the determination of coagulation factors, protein
C (PC), protein S (PS), C4b binding protein (C4bBP), antithrombin (AT), and plasminogen activator inhibitor 1 (PAI-1). Two
severity scores and CRP levels were determined at admission. Children with SNLI and without SNLI were compared. On admission,
severity scores, and AT, PC, PS, C4bBP levels were similar in both groups with and without SNLI. Prothrombin time (23% vs
34%;
P < 0.01), factor VII+X (20% vs 31%;
P = 0.05) and factor VII (0% vs 19%;
P < 0.01) were lower in the group with SNLI. The 2
nd sample showed no difference between the two groups. Kinetics of haemostatic abnormalities were no different between the two
groups.
Conclusion In this series, the only difference between the two groups was lower factor VII levels in children with skin necrosis or
limb ischaemia. This suggests the benefit of tissue factor pathway inhibitor administration as an adjunctive therapy to prevent
skin necrosis or limb ischaemia. Further studies including more children are needed to determine the potential effects of
treatments such as protein C, antithrombin, and plasminogen activator inhibitor antibody administration, and to advocate tissue
factor pathway inhibitor in preventing skin necrosis or limb ischaemia.
Key words Disseminated intra-vascular coagulation - Limb ischaemia - Purpura fulminans - Septic shock - Skin necrosis
Received: 18 November 1997 / Accepted in revised form: 2 July 1998