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Effect of Sepsis on Iron Parameters in a Population with High Prevalence of Malnutrition and Iron Deficiency: A
Arun K Baranwal1, Reena Das2, Ramachandran Rameshkumar3
1Division of Pediatric Critical Care, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Insights
Sepsis in children with iron deficiency (ID) alters iron metabolism, showing lower serum iron and higher ferritin levels. These changes, while complex, offer insights into critical illness in this vulnerable population.
Area of Science:
- Pediatric critical care
- Nutritional science
- Hematology
Background:
- Iron deficiency (ID) is prevalent in populations with high rates of childhood sepsis.
- Limited data exists on iron metabolism alterations in critically ill children with ID.
Purpose of the Study:
- To investigate the impact of sepsis on iron parameters in children with pre-existing iron deficiency.
- To compare iron status markers between pediatric sepsis patients and healthy controls.
Main Methods:
- A case-control pilot study involving 134 sepsis patients (6-59 months) and 54 healthy siblings/cousins.
- Measurement of serum iron, total iron-binding capacity (TIBC), transferrin saturation, ferritin, and soluble transferrin receptor (sTfR).
- Calculation of the sTfR-Ferritin index and Receiver Operating Characteristic (ROC) analysis.
Main Results:
- Sepsis patients exhibited significantly lower serum iron and sTfR, but higher serum ferritin compared to controls.
- The sTfR-Ferritin index was significantly lower in sepsis patients.
- Iron parameters did not correlate with mortality, potentially due to ID-associated immune dysfunction.
Conclusions:
- Sepsis induces complex alterations in iron metabolism among children with iron deficiency.
- These changes are qualitatively similar to, but quantitatively different from, those observed in non-ID adults.
- Further research is needed to understand the role of iron metabolism in sepsis outcomes in ID children.
Abstract:
There is lack of data on iron metabolism in critically ill sepsis children from population with high prevalence of iron deficiency (ID). The study was designed to study impact of sepsis on iron parameters in children with ID. Sepsis patients (age 6-59 months) and their apparently healthy sibling/cousin as controls were enrolled in this case-control pilot study. Serum iron, TIBC, transferrin saturation, ferritin and sTfR were measured in the two groups. sTfR-Ferritin index was calculated. Patients (n = 134) were significantly underweight compared to controls (n = 54) (WAZ score < - 2; 58% vs. 28%; p < 0.001). Serum iron and sTfR (mg/L) were lower [71.5 (51.0, 115.0) vs. 87.0 (64.5, 130.5), p = 0.068; 3.1 (2.1, 4.5) vs. 3.5 (2.8, 4.8), p = 0.026 respectively] while serum ferritin was higher [229 (94, 484.5) vs. 22 (9.2, 51); p < 0.001] in patients compared to controls. sTfR-Ferritin index was lower in patients [1.3 (0.8, 2.3) vs. 2.5 (1.8, 4.5); p < 0.001]. ROC AUC (patients vs. controls) were 0.89 (95% CI 0.83-0.95) and 0.76 (95% CI 0.68-0.85) for ferritin and sTfR-ferritin index respectively. Survivors and non-survivors were similar in terms of iron parameters. Sepsis-induced alterations in iron parameters among ID children are complex. Qualitatively it is similar (with quantitative differences) to non-ID adult population. Lack of correlation of iron parameters with mortality may be due to ID-associated immune dysfunction.
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