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DNA Viremia Is Associated with Hyperferritinemia in Pediatric Sepsis
Dennis W Simon1, E Scott Halstead2, Sam Davila3
1Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA; Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh, PA.
Insights
High ferritin levels in children with severe sepsis indicate a greater risk of viral DNA detection and adverse outcomes, including mortality. This suggests ferritin may help identify at-risk patients.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Hematology
Background:
- Severe sepsis in children is a life-threatening condition.
- Identifying specific risk factors and co-infections is crucial for improving outcomes.
- The role of viral DNAemia and hyperferritinemia in pediatric severe sepsis requires further elucidation.
Purpose of the Study:
- To investigate the association between DNA virus detection, ferritin levels, and clinical outcomes in pediatric patients with severe sepsis.
- To determine if hyperferritinemia can serve as a marker for viral DNAemia in this population.
Main Methods:
- A cohort of 75 pediatric patients with severe sepsis was studied.
- Plasma ferritin levels were measured serially post-diagnosis.
- Polymerase chain reaction (PCR) was used to detect DNAemia for herpes simplex virus type 1, human herpesvirus 6, Epstein-Barr virus, cytomegalovirus, and adenovirus.
Main Results:
- Patients with ferritin levels ≥1000 ng/mL had a significantly higher incidence of DNAemia (78% vs 28%).
- Higher ferritin levels correlated with the detection of multiple DNA viruses and increased mortality.
- Hyperferritinemia was linked to hepatobiliary and hematologic dysfunction, even after controlling for other infections.
Conclusions:
- Viral DNAemia is associated with hyperferritinemia and poor outcomes in pediatric severe sepsis.
- Hyperferritinemia may be a useful indicator for identifying children at risk of occult viral infections.
- Further prospective research is warranted to validate these findings.
Objective:
To evaluate the relationship between detection of DNA viruses, ferritin, and outcomes in children with severe sepsis.
Study Design:
We enrolled 75 pediatric patients with severe sepsis admitted to a tertiary care children's hospital. Plasma ferritin was measured within 48 hours of diagnosis and subsequently twice weekly. Herpes simplex type 1, human herpesvirus 6, Epstein-Barr virus, cytomegalovirus, and adenovirus DNAemia were assessed by polymerase chain reaction.
Results:
The incidence of DNAemia was increased significantly in patients with ferritin ≥1000 ng/mL (78% vs 28%; P < .05). Patients with ferritin ≥1000 ng/mL were more likely to have multiple DNA viruses detected in plasma (39% vs 4%; P < .001). The number of viruses detected in plasma directly correlated with the degree of hyperferritinemia and development of combined hepatobiliary and hematologic dysfunction after we controlled for bacterial and fungal coinfections (P < .05) as well as increased mortality after we controlled for severity of illness and cancer diagnosis (OR 2.6, 95% CI 1.1-6.3, P < .05).
Conclusions:
Viral DNAemia was associated with hyperferritinemia and adverse outcome in pediatric severe sepsis. Prospective studies are needed to determine whether hyperferritinemia may be used to identify patients at risk of occult DNAemia.
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