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Serum Ferritin Levels in Critically Ill Children With Severe Sepsis and Their Relationship With Mortality: A
Kirti Pai1, Suresh Kumar Angurana1, Karthi Nallasamy1
1From the Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Insights
Hyperferritinemia, elevated serum ferritin levels, is common in critically ill children with severe sepsis. This condition is significantly associated with increased mortality risk in this vulnerable pediatric population.
Area of Science:
- Pediatric Critical Care Medicine
- Infectious Diseases
- Clinical Biochemistry
Background:
- Severe sepsis in children is a life-threatening condition with significant morbidity and mortality.
- Serum ferritin, an iron storage protein, has emerged as a potential biomarker in critical illness.
- Understanding hyperferritinemia in pediatric sepsis is crucial for risk stratification and management.
Purpose of the Study:
- To determine serum ferritin levels in critically ill children with severe sepsis.
- To establish the prevalence of hyperferritinemia (ferritin >500 ng/mL) in this cohort.
- To investigate the association between serum ferritin levels and mortality in pediatric severe sepsis.
Main Methods:
- Prospective study conducted in a pediatric intensive care unit in North India.
- Enrolled 115 children aged 3 months to 12 years with severe sepsis.
- Measured serum ferritin levels at admission and analyzed correlation with mortality and clinical severity scores.
Main Results:
- 52% of children with severe sepsis had hyperferritinemia (median ferritin 550 ng/mL).
- Nonsurvivors exhibited significantly higher serum ferritin levels compared to survivors (P=0.01).
- Hyperferritinemia was associated with increased mortality (38.3% vs 16.4%, P=0.012) and higher organ dysfunction.
Conclusions:
- Hyperferritinemia is a frequent finding in critically ill children with severe sepsis.
- Elevated serum ferritin levels are significantly associated with increased mortality in this population.
- Serum ferritin may serve as a valuable prognostic biomarker in pediatric severe sepsis.
Objectives:
To determine the serum ferritin levels, single-center prevalence of hyperferritinemia and its association with mortality in critically ill children with severe sepsis.
Methods:
This prospective study was conducted in pediatric intensive care unit of a tertiary care teaching hospital in North India over a period of 13 months (June 2023-June 2024), including children 3 months-12 years old with severe sepsis. At admission, blood was collected for estimation of serum ferritin levels. Hyperferritinemia was defined as ferritin levels >500 ng/mL. The primary outcome was to determine the association between serum ferritin and mortality; and secondary outcomes were estimation of serum ferritin levels, single-center prevalence of hyperferritinemia, best cutoff of serum ferritin to predict mortality, and correlation of serum ferritin with severity scores.
Results:
We enrolled 115 children with a median (interquartile range) age of 3 (1-7) years. The common diagnoses were community-acquired pneumonia (39.1%), scrub typhus (13.9%), CNS infections (10.4%), multisystem viral infection (10.4%), dengue (9.6%), GI sepsis (6.1%), and disseminated Staphylococcal sepsis (4.3%). The median (interquartile range) serum ferritin level was 550 (233-1633) ng/mL and 52% (n = 60) had hyperferritinemia. Nonsurvivors had significantly higher serum ferritin levels compared with survivors [1355 (860-4435) vs. 233 (108-306), P = 0.01]. The mortality was significantly higher in children with hyperferritinemia (38.3% vs 16.4%, P = 0.012). The best cutoff of serum ferritin to predict mortality was 705 ng/mL (Area under curve [AUC]: 0.653, sensitivity and specificity of 63% each, P = 0.011). Children with hyperferritinemia had a longer duration of illness and higher occurrence of organ dysfunction (coagulopathy, hepatic dysfunction, shock, acute respiratory distress syndrome and acute kidney injury). Serum ferritin was positively correlated with pediatric risk of mortality III score ( ρ = 0.342, P = 0.001) pediatric logistic organ dysfucntion-2 score on day 2 ( ρ = 0.204, P = 0.042) and day 5 ( ρ = 0.235, P = 0.046) and vasoactive inotropic score on day 1 ( ρ = 0.305, P = 0.033).
Conclusion:
Hyperferritinemia was common in critically ill children with severe sepsis and was significantly associated with mortality.
