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Cardiac dysfunction and ferritin as early markers of severity in pediatric sepsis
Cristian T Tonial1, Pedro Celiny R Garcia2, Louise Cardoso Schweitzer3
1Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Hospital São Lucas, Unidade de Terapia Intensiva, Porto Alegre, RS, Brazil; Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Programa de Pós-Graduação em Pediatria e Saúde da Criança, Porto Alegre, RS, Brazil.
Insights
Echocardiogram findings and elevated ferritin levels in pediatric sepsis patients are linked to worse outcomes, including longer hospital stays and increased need for mechanical ventilation. These markers can help predict sepsis severity in children.
Area of Science:
- Pediatric critical care medicine
- Cardiology
- Infectious diseases
Background:
- Pediatric sepsis is a life-threatening condition requiring early identification of risk factors.
- Predictive markers for unfavorable outcomes in pediatric sepsis are crucial for timely intervention.
Purpose of the Study:
- To investigate the association between echocardiogram parameters, serum ferritin, C-reactive protein, and leukocyte count with adverse outcomes in pediatric sepsis.
Main Methods:
- Prospective cohort study of pediatric critical care patients diagnosed with sepsis.
- Echocardiography assessed left ventricular ejection fraction; serum ferritin, CRP, and leukocyte counts were measured serially.
- Outcomes included length of stay, mechanical ventilation duration, and mortality.
Main Results:
- Elevated ferritin levels correlated with fewer ventilator-free hours and higher inotropic scores.
- Cardiac dysfunction identified by echocardiography was associated with longer hospital and PICU stays, increased mechanical ventilation duration, and higher inotropic scores.
Conclusions:
- Echocardiographic evidence of cardiac dysfunction and elevated serum ferritin are significant predictors of unfavorable outcomes in pediatric sepsis.
Objective:
The aim of this study was to verify the association of echocardiogram, ferritin, C-reactive protein, and leukocyte count with unfavorable outcomes in pediatric sepsis.
Methods:
A prospective cohort study was carried out from March to December 2014, with pediatric critical care patients aged between 28 days and 18 years. Inclusion criteria were diagnosis of sepsis, need for mechanical ventilation for more than 48h, and vasoactive drugs. Serum levels of C-reactive protein, ferritin, and leukocyte count were collected on the first day (D0), 24h (D1), and 72h (D3) after recruitment. Patients underwent transthoracic echocardiography to determine the ejection fraction of the left ventricle on D1 and D3. The outcomes measured were length of hospital stay and in the pediatric intensive care unit, mechanical ventilation duration, free hours of VM, duration of use of inotropic agents, maximum inotropic score, and mortality.
Results:
Twenty patients completed the study. Patients with elevated ferritin levels on D0 had also fewer ventilator-free hours (p=0.046) and higher maximum inotropic score (p=0.009). Patients with cardiac dysfunction by echocardiogram on D1 had longer hospital stay (p=0.047), pediatric intensive care unit stay (p=0.020), duration of mechanical ventilation (p=0.011), maximum inotropic score (p=0.001), and fewer ventilator-free hours (p=0.020).
Conclusion:
Cardiac dysfunction by echocardiography and serum ferritin value was significantly associated with unfavorable outcomes in pediatric patients with sepsis.
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