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Published on: November 27, 2016
Elevated total bile acid levels as an independent predictor of mortality in pediatric sepsis
Yanfei Wang1, Kelei Deng1, Peiquan Lin1
1Department of Surgical ICU, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
Insights
Elevated total bile acid (TBA) levels are linked to increased mortality risk in pediatric sepsis. Higher TBA levels in critically ill children predict a poorer prognosis, highlighting its potential as a biomarker.
Area of Science:
- Pediatric critical care medicine
- Metabolomics and gut microbiome research
- Sepsis pathophysiology
Background:
- Growing evidence links bile acid (BA) metabolism to sepsis.
- The roles of the gut microbiome and metabolomics in sepsis are increasingly understood.
Purpose of the Study:
- To investigate the association between bile acid metabolism and sepsis outcomes in children.
- To identify potential biomarkers for predicting sepsis mortality in pediatric patients.
Main Methods:
- A cohort study involving pediatric sepsis patients and non-infectious controls.
- Clinical data collection and statistical analysis were performed.
Main Results:
- Total bile acid (TBA) levels were elevated in both early and severe pediatric sepsis.
- TBA was identified as a significant risk factor for sepsis and an independent predictor of mortality.
- A clinical model using TBA (>17.95 µmol/L) showed high accuracy (AUC 0.842) in predicting sepsis mortality.
Conclusions:
- Elevated serum TBA levels are associated with increased mortality risk in pediatric sepsis.
- Serum TBA levels can serve as a valuable biomarker for predicting sepsis prognosis in children.
- Significant differences in TBA levels were observed between sepsis survivors, non-infected controls, and those with fatal outcomes.
Background:
The close relationship between bile acid (BA) metabolism and sepsis has been investigated in recent years, as knowledge of the role of the gut microbiome and metabolomics in sepsis has grown and become more comprehensive.
Methods:
Patients with sepsis who were admitted to the PICU of the Children's Hospital, Zhejiang University School of Medicine from January 2016 to December 2021 were enrolled in this study. Preoperative non-infectious pediatric patients undergoing elective surgeries in our hospital's department of surgery were recruited as controls during the same period. Clinical data were collected and analyzed.
Results:
702 children were enrolled, comprising 538 sepsis survivors, 164 sepsis fatalities, and 269 non-infected controls. Statistical analysis revealed that total BA (TBA) increased in both the early and severe stages of pediatric sepsis. In the severe stage, TBA (OR = 2.898, 95% CI 1.946-4.315, p < 0.05) was identified as a risk factor for sepsis. A clinical model identified TBA (the cut-off value is >17.95 µmol/L) as an independent predictor of sepsis mortality with an AUC of 0.842 (95% CI 0.800-0.883), sensitivity of 54.9%, specificity of 96.6%, and HR = 7.658 (95% CI 5.575-10.520).
Conclusions:
The study showed that elevated TBA was associated with a heightened risk of mortality in pediatric sepsis.
Impact:
Many clinical indicators show differences between children with sepsis and the control group, among which the difference in serum total bile acid levels is the most significant. During the hospitalization of the patients, the overall bile acid levels in the sepsis death group were higher and exhibited greater fluctuations compared to the survival group, with significant differences. Serum total bile acid levels can serve as effective biomarker for predicting the prognosis of children with sepsis.
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