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Ferritin in pediatric critical illness: a scoping review
Ivy Cerelia Valerie1, Anak Agung Sagung Mirah Prabandari2, Dyah Kanya Wati1
1Department of Child Health, Faculty of Medicine, Universitas Udayana/Sanglah General Hospital, Bali, Indonesia.
Insights
Serum ferritin effectively predicts outcomes in critical pediatric illness. Elevated levels indicate higher risks for mortality and morbidity, guiding clinical decisions.
Area of Science:
- Pediatric Critical Care Medicine
- Biomarker Research
- Clinical Diagnostics
Background:
- Serum ferritin is a key iron storage protein.
- Its role in predicting critical pediatric illness outcomes requires comprehensive summarization.
Purpose of the Study:
- To elucidate and summarize the predictive value of serum ferritin in critically ill children.
- To identify thresholds and their association with mortality and morbidity.
Main Methods:
- A scoping review methodology was employed, adhering to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.
- Searched five databases (MEDLINE, CENTRAL, ProQuest, ScienceDirect, Epistemonikos) for studies on pediatric serum ferritin levels and critical illness.
- Independently screened and reviewed primary research studies involving subjects under 18 years.
Main Results:
- Analyzed 66 studies out of 1,580 retrieved.
- Serum ferritin was significantly higher in patients with critical conditions compared to controls.
- As a categorical variable, ferritin predicted outcomes in 84.6% of studies, with 22 thresholds linked to mortality, morbidity, and specific conditions.
Conclusions:
- Serum ferritin is a significant predictor of outcomes in critical pediatric illness.
- Standardizing measurement precision and threshold modeling is crucial for clinical application.
- Further research should focus on refining predictive models for better patient management.
Abstract:
This scoping review aimed to elucidate and summarize the predictive role of serum ferritin in critical pediatric illness. The Preferred Reporting Items for Systematic reviews and Meta-Analyses methodology was employed to conduct a scoping review of 5 databases (MEDLINE, CENTRAL, ProQuest, ScienceDirect, and Epistemonikos) from the date of inception through January 24, 2022. Primary research studies involving subjects aged <18 years and serum ferritin levels were screened and reviewed independently following an a priori defined protocol. Of the 1,580 retrieved studies, 66 were analyzed. Summary statistics of serum ferritin levels for overall and condition-specific studies were reported in 30 (45.4%) and 47 studies (71.2%), respectively. The normal range was defined in 16 studies (24.2%), whereas the threshold was determined in 43 studies (65.1%). A value of <500 ng/mL was most often the upper limit of the normal range. Serum ferritin as a numerical variable (78.9%) was usually significantly higher (80.8%) in the predicted condition than in controls, while as a categorical variable with preset thresholds, ferritin was a significant predictor in 84.6% of studies. A total of 22 predictive thresholds predicted mortality (12 of 46 [26.1%]), morbidity (18 of 46 [39.1%]), and specific (16 of 46 [34.8%]) outcomes in 15 unique conditions. Increased precision in serum ferritin measures followed by close attention to the threshold modeling strategy and reporting can accelerate the translation from evidence to clinical practice.
