الفهرس 
Eman Saleh El-Hadidi Pediatric Intensive Care UnitsOnly 14 pages are availabe for public view
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Abstract
The aim of our work was to study the prognostic value of H-FABP in pediatric patients admitted to the pediatric intensive care unit in relation to patient survival during same hospital admission, the need for inotropic support and/or mechanical ventilation, and the length of stay in the PICU. Additionally, we evaluated the prognostic value of the PIM2 score in these patients in relation to the same outcomes.
The study included all patients admitted to PICU over the period from April 2006 to July 2006. Fifty-six cases were included in the study, and 20 apparently healthy age and sex –matched children were studied as a control group .
The most common cause of hospital admission was respiratory diseases (30%), while the most common indications for PICU admission were shock (30%), and respiratory distress (26%).
When we compared patients and control as regards the different laboratory parameters, patients had significantly lower hemoglobin concentrations when compared to controls and higher potassium (K) levels and WBC counts than controls. Additionally Patients had significantly higher H-FABP level than controls.
Comparison of ECG parameters between patients and controls revealed that patients had a significantly higher heart rates, prolonged PR intervals, and longer QTc intervals than controls.
As regards the primary outcome (death vs recovery) the results demonstrated that 27 patients (48.2%) recovered and were discharged from the PICU. All these patients were later discharged from hospital with no further deaths. Twenty-nine patients (51.8%) died.
The PIM2 score was higher in patients who died. Also patients who died had significantly higher values for H-FABP than patients who recovered.
The PIM2 score and H-FABP level were considered the best independent predictors of the primary outcome, and the combination of both markers improved the sensitivity and specificity and constituted the best independent predictor of death as an outcome.
As regards the secondary outcomes (use of inotrope, mechanical ventilation), the number of patients who needed mechanical ventilation was 20 (35.7%), while 16 patients (28.6%) required inotropic support during the period of the stay.
We observed that the PIM2 score and the number of system affected constituted the best independent predictors for the need for inotropic support, while that the PIM2 and H-FABP level were considered the best independent predictors of the need for mechanical ventilation.
PIM2 and H- FABP were considered the best independent predictors of length of hospital stay.
The results of our study demonstrated that initial assessment on admission to the PICU using the PIM2 clinical scoring system and the level of H-FABP can help in risk stratification of patients and predict mortality with a sensitivity of 81%.
Also the need for inotropic support and for mechanical ventilation can potentially be predicted by the initial assessment of the PIM2 and number of affected systems for the former, and the PIM2 score and H-FABP level for the latter. This can have far- reaching effects on the plan of management of actually ill children admitted to the PICU, and may potentially improve outcome. Furthermore studies are needed to assess the value of the application of better parameter in patient care.