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A Controlled Mouse Model for Neonatal Polymicrobial Sepsis

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Mortality Risk in Pediatric Sepsis Based on C-reactive Protein and Ferritin Levels.

Christopher M Horvat¹, Anthony Fabio², Daniel S Nagin²

¹Division of Pediatric Critical Care Medicine, Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA.

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

|September 30, 2022

Summary

Bedside C-reactive protein (CRP) and ferritin levels can identify pediatric sepsis patients with varying inflammatory responses and mortality risks. These biomarkers may guide personalized anti-inflammatory therapies.

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Area of Science:

Pediatric critical care medicine
Sepsis pathophysiology
Biomarker discovery

Background:

Interest in C-reactive protein (CRP) and ferritin for hyperinflammatory sepsis identification has grown, particularly post-COVID-19.
Identifying distinct patient trajectories is crucial for targeted anti-inflammatory therapies.

Purpose of the Study:

To identify patterns in CRP and ferritin trajectories in critically ill pediatric sepsis patients.
To examine associations between these patterns, cytokine responses, inflammation, and mortality.

Main Methods:

Prospective, observational cohort study of 255 children with sepsis and organ failure.
Group-based multi-trajectory modeling (GBMTM) used to define CRP and ferritin patterns.
Plasma CRP, ferritin, and 31 cytokine levels measured at two timepoints.

Main Results:

Five distinct CRP and ferritin trajectory groups were identified.
Mortality rates varied significantly across groups, from 0% to 40%.
Group 5 (very high CRP and ferritin) had the highest mortality (40%).
Cytokine responses differed across groups; ferritin correlated with macrophage inflammatory protein 1α.

Conclusions:

Bedside CRP and ferritin levels effectively distinguish pediatric sepsis patient groups with different inflammatory profiles and mortality risks.
These findings support the potential utility of CRP and ferritin in personalized clinical trials for anti-inflammatory treatments.