Related Experiment Video
Updated: Aug 27, 2025
A Controlled Mouse Model for Neonatal Polymicrobial Sepsis
Published on: January 27, 2019
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.
Insights
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.
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.
Objectives:
Interest in using bedside C-reactive protein (CRP) and ferritin levels to identify patients with hyperinflammatory sepsis who might benefit from anti-inflammatory therapies has piqued with the COVID-19 pandemic experience. Our first objective was to identify patterns in CRP and ferritin trajectory among critically ill pediatric sepsis patients. We then examined the association between these different groups of patients in their inflammatory cytokine responses, systemic inflammation, and mortality risks.
Data Sources:
A prospective, observational cohort study.
Study Selection:
Children with sepsis and organ failure in nine pediatric intensive care units in the United States.
Data Extraction:
Two hundred and fifty-five children were enrolled. Five distinct clinical multi-trajectory groups were identified. Plasma CRP (mg/dL), ferritin (ng/mL), and 31 cytokine levels were measured at two timepoints during sepsis (median Day 2 and Day 5). Group-based multi-trajectory models (GBMTM) identified groups of children with distinct patterns of CRP and ferritin.
Data Synthesis:
Group 1 had normal CRP and ferritin levels ( n = 8; 0% mortality); Group 2 had high CRP levels that became normal, with normal ferritin levels throughout ( n = 80; 5% mortality); Group 3 had high ferritin levels alone ( n = 16; 6% mortality); Group 4 had very high CRP levels, and high ferritin levels ( n = 121; 11% mortality); and Group 5 had very high CRP and very high ferritin levels ( n = 30; 40% mortality). Cytokine responses differed across the five groups, with ferritin levels correlated with macrophage inflammatory protein 1α levels and CRP levels reflective of many cytokines.
Conclusions:
Bedside CRP and ferritin levels can be used together to distinguish groups of children with sepsis who have different systemic inflammation cytokine responses and mortality risks. These data suggest future potential value in personalized clinical trials with specific targets for anti-inflammatory therapies.
Related Concept Videos
01:19Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...
01:22Acute Kidney Injury I: Introduction
01:24Serum Studies: Renal Function Tests