Mortality Associated with Recurrent Extreme Hyperferritinemia in Critically Ill Adolescents

Area of Science:

• Critical care medicine
• Pediatric hematology
• Immunology

Background:

• Recurrent extreme hyperferritinemia (ferritin >10,000 ng/mL) has not been previously described in critically ill adolescents.
• Systemic inflammation, including cytokine storm syndrome and hemophagocytic lymphohistiocytosis, is a critical condition in adolescents.

Purpose of the Study:

• To investigate the association between recurrent extreme hyperferritinemia and mortality in critically ill adolescents.
• To identify common factors in critically ill adolescents experiencing recurrent extreme hyperferritinemia and systemic inflammation.

Main Methods:

• Retrospective review of medical records of 4 critically ill adolescents.
• Analysis of epidemiologic factors, systemic inflammation markers, and clinical outcomes.

Main Results:

• All 4 patients exhibited recurrent extreme hyperferritinemia, with episodes occurring at least twice.
• Extreme hyperferritinemia episodes were linked to multiple organ dysfunction syndrome in 80% of cases.
• Death occurred within two weeks of recurrent extreme hyperferritinemia onset; lymphocytopenia and cachexia were common.

Conclusions:

• Recurrent extreme hyperferritinemia, particularly with multiple organ dysfunction syndrome, is associated with mortality in critically ill adolescents.
• This condition may serve as a novel biomarker for increased mortality in patients with persistent inflammation, immunosuppression, and catabolism (PICS).