A Systemic Inflammation Mortality Risk Assessment Contingency Table for Severe Sepsis

Area of Science:

• Pediatric critical care medicine
• Biomarker research
• Sepsis management

Background:

• Severe sepsis poses a significant mortality risk in children.
• Accurate risk stratification is crucial for timely intervention.
• Existing biomarkers may not fully capture the dynamic inflammatory state in pediatric sepsis.

Purpose of the Study:

• To evaluate the utility of a C-reactive protein (CRP) and ferritin-based contingency table in predicting mortality risk in pediatric severe sepsis.
• To identify optimal CRP and ferritin thresholds for risk assessment.
• To explore the association of risk categories with outcomes like immunoparalysis and macrophage activation syndrome.

Main Methods:

• A prospective cohort study was conducted in a tertiary pediatric intensive care unit (PICU).
• 100 children with severe sepsis were enrolled, with blood samples collected on day 2 and bi-weekly.
• A 2x2 contingency table was developed using CRP and ferritin levels with Youden index-determined optimal cutoffs (CRP ≥ 4.08 mg/dL, ferritin ≥ 1,980 ng/mL).

Main Results:

• The high-risk category (CRP ≥ 4.08 mg/dL and ferritin ≥ 1,980 ng/mL) showed significantly increased PICU mortality (46.15%) compared to intermediate (4.65%) and low-risk (0%) categories.
• High-risk status was associated with higher odds of immunoparalysis (OR, 4.47) and macrophage activation syndrome (OR, 24.20).
• Patients migrating to or remaining in the low-risk category had improved survival, while those in at-risk categories had higher mortality.

Conclusions:

• A CRP and ferritin-based contingency table is an effective tool for assessing mortality risk in pediatric severe sepsis.
• Achieving systemic inflammation levels below the combined thresholds of CRP < 4.08 mg/dL and ferritin < 1,980 ng/mL appears to be a favorable prognostic indicator.
• This biomarker-based approach aids in risk stratification and monitoring treatment response in critically ill children.