Abstract
Objective
To explore association between serum ferritin and severity of sepsis among children, and relate levels to the final outcome.
Methods
This observational study was conducted in a tertiary care hospital between I February and 30 July, 2019. Serum ferritin level was estimated in children (age 6 months to 12 years) suffering from sepsis, irrespective of the probable etiology. Children with hemoglobinopathies, autoimmune diseases, previous blood transfusion, severe acute malnutrition, hemophagocytic lymphohistiocytosis and chronic hepatitis were excluded. The ferritin level was measured sequentially at pre-defined stages of illness viz., sepsis, severe sepsis, septic shock and multiorgan dysfunction syndrome (MODS). Association between serum ferritin and severity of sepsis was analyzed, and ferritin level was related to the final outcome of death or recovery by receiver operating characteristic (ROC) curve analysis.
Results
The study group included 47 children with sepsis who progressed to a state of MODS; 32 recovered from MODS. Significant differences in serum ferritin level were observed with severity of sepsis. There was clear demarcation of ferritin levels between sepsis severity stages. The proportion of death among the 47 MODS cases was 31.9% (95% CI 18.6–45.2%). ROC analysis in the MODS group indicated that serum ferritin >1994.3 ng/mL predicts mortality (AUC 0.73 [95% CI 0.58–0.85]) with sensitivity 66.7% [95% CI 38.4–88%] and specificity 100.0% [95% CI 89.1–100%].
Conclusions
There is clear demarcation of serum ferritin levels that can help differentiation of sepsis severity stages in children with sepsis. There is no such demarcation between survivors and non-survivors in MODS cases.
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References
Kutko MC, Calarco MP, Flaherty MB, et al. Mortality rates in pediatric septic shock with and without multiple organ system failure. Pediatr Crit Care Med. 2003;4:333–7
Schlapbach LJ, Kissoon N. Defining pediatric sepsis. JAMA Pediatr. 2018;172: 312–4.
De Backer D, Orbegozo Cortes D, Donadello K, Vincent JL. Pathophysiology of microcirculatory dysfunction and the pathogenesis of septic shock. Virulence. 2014;5:73–9
Carcillo JA, Simon DW, Podd BS. How we manage hyperferritinemic sepsis related MODS/Macrophage Activation Syndrome/Secondary HLH. Pediatr Crit Care Med. 2015;16:598–600.
Carcillo JA. Pediatric septic shock and multiple organ failure. Crit Care Clin. 2003;19:413–40.
Kyriazopoulou E, Leventogiannis K, Norrby-Teglund A, et al. Macrophage activation-like syndrome: An immunological entity associated with rapid progression to death in sepsis. BMC Med. 2017;15:2–10
Kawasaki T. Update on pediatric sepsis: A review. J Intensive Care. 2017;5:2–12.
Garcia PC, Longhi F, Branco RG, Piva JP, Lacks D, Tasker RC. Ferritin levels in children with severe sepsis and septic shock. Acta Paediatr. 2007;96:1829–31.
Glodstein B, Giroir B, Randolph A. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med. 2005;6:2–8
Kernan KF, Carcillo JA. Hyperferritinemia and inflammation. Int Immunol. 2017; 29:401–9.
Torti FM, Torti SV. Regulation of ferritin genes and protein. Blood. 2002;99: 3505–16.
Rosário C, Zandman-Goddard G, Meyron-Holtz EG, D’Cruz DP, Shoenfeld Y. The hyperferritinemic syndrome: macrophage activation syndrome, Still’s disease, septic shock and catastrophic antiphospholipid syndrome. BMC Med. 2013;11:2–11.
Fernando SM, Rochwerg B, Seely AJE. Clinical implications of the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). CMAJ. 2018;190:E1058–9.
Sankar J, Dhochak N, Kumar K, Singh M, Sankar MJ, Lodha R. Comparison of International Pediatric Sepsis Consensus Conference versus Sepsis-3 definitions for children presenting with septic shock to a tertiary care center in India: A retrospective study. Pediatr Crit Care Med. 2019;20: e122–9.
Tonial CT, Garcia PCR, Schweitzer LC, Costa CAD, Bruno F, Fiori HH. Cardiac dysfunction and ferritin as early markers of severity in pediatric sepsis. J Pediatr (Rio J). 2017;93: 301–7.
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Contributions
Contributors: AN: primary investigator, data collection, making draft; TM: making draft, literature search, interpretation, statistical help; DD: draft, patient management, literature search; SR: study review, Review draft and interpretation; NK: technical inputs, data Collection, data interpretation; IM: reviewing draft, study interpretation, literature search: AH: literature search, review draft, statistical analysis; RM: conception of study, reviewing draft, study design, and literature search.
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Ethics declarations
Ethics clearance: Institutional ethics committee of NB Medical College; No. IEC/NBMC/2018-19/91, dated: February 01, 2019.
Competing interest: None stated.
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Nandy, A., Mondal, T., Datta, D. et al. Serum Ferritin as a Diagnostic Biomarker for Severity of Childhood Sepsis. Indian Pediatr 58, 1143–1146 (2021). https://doi.org/10.1007/s13312-021-2396-y
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DOI: https://doi.org/10.1007/s13312-021-2396-y