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Published on: January 19, 2024
Serum ferritin levels as a simple prognostic tool in pediatric sepsis: relevance for primary care practice. A
Sarika Gupta1, Vinod Kumar1, Akanksha D Srivastava2
1Department of Pediatrics, King George Medical University, Lucknow, India.
Insights
Hyperferritinemia, or high ferritin levels, is common in pediatric sepsis and septic shock. High ferritin predicts septic shock and is linked to increased mortality, suggesting its use as a prognostic marker.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Biomarker research
Background:
- Hyperferritinemia is an emerging indicator of inflammation and severity in sepsis.
- The predictive value of ferritin for septic shock and patient outcomes requires further investigation.
Purpose of the Study:
- To evaluate serum ferritin levels as a predictor of septic shock (SS) in children.
- To assess the association between hyperferritinemia and clinical outcomes in pediatric sepsis.
Main Methods:
- Prospective observational study of 123 children with severe sepsis and SS in North India.
- Serum ferritin levels measured; hyperferritinemia defined as >500 ng/ml.
- Statistical analysis including ROC curves to determine predictive strength for SS and outcomes.
Main Results:
- Hyperferritinemia observed in 66.6% of patients, with significantly higher levels in SS.
- Serum ferritin ≥ 730 ng/ml predicted SS (AUC = 0.80, p=0.02).
- Mortality was significantly higher in patients with hyperferritinemia (OR=12.9, p=0.001).
Conclusions:
- Hyperferritinemia is prevalent in pediatric sepsis and SS, strongly associated with increased mortality.
- Serum ferritin demonstrates potential as a prognostic biomarker for identifying high-risk pediatric sepsis patients.
- A ferritin level of 2,214 ng/ml predicted secondary hemophagocytic lymphohistiocytosis with high sensitivity and specificity.
Abstract:
Hyperferritinemia is increasingly recognized as a marker of inflammation and severity in sepsis. This study aimed to ascertain the level of ferritin as a predictor of septic shock (SS) and its association with outcome. A prospective observational study was conducted on 123 children diagnosed with severe sepsis and SS at a tertiary care hospital of North India. Serum ferritin levels were measured, with hyperferritinemia defined as levels >500 ng/ml. Good outcome was defined as discharge or improving clinical status, and bad outcome was defined as death or clinical deterioration. The association of hyperferritinemia with SS and clinical outcomes was analyzed and statistically evaluated. Analysis of the area under the curve (AUC) and the receiver operating characteristic (ROC) curve was constructed to assess the predictive strength of ferritin as a marker of SS. Sensitivity, specificity, and positive and negative likelihood ratios were calculated at different cutoff values of serum ferritin. Hyperferritinemia was found in 66.6% of patients, with significantly higher levels in SS (1,624.67 ± 1,522.02 ng/ml) than sepsis (727.02 ± 1,081.12 ng/ml, p = 0.005). Hyperferritinemia (serum ferritin ≥ 730 ng/ml) was a predictor of SS (AUC = 0.80; 95% CI = 0.72-0.89; p value = 0.02). Mortality was higher in patients with hyperferritinemia (odd ratio = 12.9; 95% CI = 1.67-99.90; p value = 0.001). Serum ferritin at a level of 2,214 ng/ml was found to be predictive of secondary hemophagocytic lymphohistiocytosis (sensitivity of 100% and specificity of 94.8%). Hyperferritinemia is prevalent in pediatric sepsis and SS and is significantly associated with higher mortality. Serum ferritin may serve as a potential prognostic marker for identifying high-risk patients.