Thrombomodulin is associated with increased mortality and organ failure in mechanically ventilated children with acute respiratory failure: biomarker analysis from a multicenter randomized controlled trial.

Summary

Ancillary biomarker study to the multicentre RESTORE sedation trial, measuring plasma soluble thrombomodulin in 432 mechanically ventilated children aged 2 weeks to 17 years with acute respiratory failure. Higher soluble thrombomodulin within five days of intubation was associated with 90-day mortality, worse oxygenation index and extrapulmonary multiorgan failure after adjustment for age, race, sex and PRISM-III. The authors argue this supports a role for vascular endothelial injury in the pathogenesis of paediatric acute respiratory failure and possible prognostic enrichment for trials. Relevant to PICU clinicians interested in risk stratification in PARDS, though not yet a bedside test.

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