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Serum Ferritin as a Diagnostic Biomarker for Severity of Childhood Sepsis
Arnab Nandy1, Tanushree Mondal2, Debadyuti Datta1
1Department of Pediatrics, NB Medical College, Siliguri, West Bengal.
Insights
Serum ferritin levels can differentiate sepsis severity in children. However, elevated ferritin levels (>1994.3 ng/mL) did not predict mortality in children with severe sepsis and multiorgan dysfunction syndrome.
Area of Science:
- Pediatric critical care medicine
- Biomarker research
- Infectious diseases
Background:
- Sepsis is a life-threatening condition in children.
- Serum ferritin is an iron storage protein with potential inflammatory roles.
- Accurate assessment of sepsis severity and prognosis is crucial for effective management.
Purpose of the Study:
- To investigate the association between serum ferritin levels and sepsis severity in pediatric patients.
- To determine if serum ferritin levels can predict the outcome (mortality or recovery) in children with sepsis.
Main Methods:
- Observational study in a tertiary care hospital (February-July 2019).
- Serum ferritin levels measured sequentially in children (6 months-12 years) with sepsis.
- Exclusion criteria included hemoglobinopathies, autoimmune diseases, and malnutrition.
- Ferritin levels analyzed across sepsis stages: sepsis, severe sepsis, septic shock, and multiorgan dysfunction syndrome (MODS).
- Receiver operating characteristic (ROC) curve analysis used to assess predictive value for mortality.
Main Results:
- 47 children with sepsis progressed to MODS; 32 recovered.
- Significant differences in serum ferritin levels were observed across sepsis severity stages.
- Serum ferritin levels clearly demarcated different stages of sepsis severity.
- In the MODS group, serum ferritin >1994.3 ng/mL predicted mortality with 100% specificity (AUC 0.73).
Conclusions:
- Serum ferritin levels effectively differentiate sepsis severity stages in pediatric patients.
- While ferritin levels correlate with sepsis severity, they did not show a clear demarcation between survivors and non-survivors in the multiorgan dysfunction syndrome group.
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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