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Multiorgan dysfunction syndrome in sepsis: Is macrophage activation syndrome secondary to infection?

Arnab Nandy1, Tanushree Mondal2, Mihir Sarkar3

  • 1Department of Pediatrics, NB Medical College, Darjeeling, India.

European Journal of Rheumatology
|November 23, 2020
PubMed

Insights

Macrophage activation syndrome (MAS) significantly increases in children with septic shock progressing to multiorgan dysfunction syndrome (MODS). MAS is a key factor in sepsis-induced MODS, warranting further research for therapeutic strategies.

Area of Science:

  • Pediatric critical care medicine
  • Rheumatology
  • Immunology

Background:

  • Sepsis is a life-threatening organ dysfunction caused by dysregulated host response to infection.
  • Macrophage activation syndrome (MAS) is a severe, hyperinflammatory condition.
  • The relationship between MAS and multiorgan dysfunction syndrome (MODS) in pediatric septic shock requires further elucidation.

Purpose of the Study:

  • To investigate the prevalence and progression of macrophage activation syndrome (MAS) in children experiencing septic shock.
  • To determine if MAS is a contributing factor to the development of multiorgan dysfunction syndrome (MODS) in pediatric septic shock.

Main Methods:

  • A prospective observational study involving 127 children (6 months to 12 years) with septic shock.
  • Application of the Paediatric Rheumatology International Trials Organisation Collaborative Initiative (PRINTO) criteria for MAS at different stages of sepsis.
  • Comparison of MAS criteria fulfillment between patients who progressed to MODS and those who recovered without MODS.

Main Results:

  • At initial septic shock assessment, MAS criteria were met by comparable proportions of subjects in both eventual MODS and non-MODS groups (approx. 20-25%).
  • By the time of MODS progression, 81.13% of the MODS cohort met MAS criteria, compared to 16.18% in the non-MODS cohort (p<0.001).
  • A significant increase in MAS prevalence was observed as sepsis progressed to MODS, while it declined in recovered patients.

Conclusions:

  • The study supports the hypothesis that MODS in pediatric sepsis is a manifestation of MAS secondary to the infection.
  • Findings suggest a strong link between MAS and the development of MODS in pediatric septic shock.
  • Larger cohort studies are recommended to validate these findings and explore potential therapeutic interventions targeting MAS in sepsis.
Abstract

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