Department of Pediatrics, School of Medicine and Pediatric Intensive Care of Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil.
Post-graduate Program in Pediatrics and Child Health, School of Medicine and Pediatric Intensive Care of Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil.
Pediatr Crit Care Med. 2020 May;21(5):e259-e266. doi: 10.1097/PCC.0000000000002273.
To evaluate serum ferritin measured within 48 hours of admission as a prognostic marker and examine the association with unfavorable outcomes in a population of pediatric patients with sepsis and high prevalence of iron deficiency anemia in which this biomarker is routinely measured.
Retrospective cohort study.
PICU of a tertiary care teaching hospital in a middle-income country in South America.
All patients 6 months to 18 years old (n = 350) admitted with a diagnosis of sepsis, suspected or proven, were eligible for inclusion. Exclusion criteria were length of PICU stay less than 8 hours and inherited or acquired disorder of iron metabolism that could interfere with serum ferritin levels.
None.
Three-hundred twelve patients had their ferritin levels measured within 48 hours, and only 38 did not. The prevalence of iron deficiency anemia (hemoglobin < 11 g/dL and mean corpuscular volume < 80 fl was 40.3%. The median of the highest serum ferritin level within 48 hours was 150.5 ng/mL (interquartile range, 82.25-362 ng/mL), being associated with mortality (p < 0.001; Exp(B), 5.170; 95% CI, 2.619-10.205). A 10-fold increase in ferritin level was associated with a five-fold increase in mortality. There was a monotonic increase in mortality with increasing ferritin levels (p < 0.05). Regarding the discriminatory power of ferritin for mortality, the area under the receiver operating characteristic curve was 0.787 (95% CI, 0.737-0.83; p < 0.0001).
Serum ferritin at lower thresholds predicts mortality in children with sepsis admitted to the ICU in a middle-income country with high prevalence of iron deficiency anemia.
评估入院 48 小时内的血清铁蛋白作为预后标志物，并在一个儿童脓毒症患者人群中检查其与不良结局的相关性，该人群中缺铁性贫血的患病率较高，且常规测量该生物标志物。
回顾性队列研究。
南美洲一个中等收入国家的三级保健教学医院的 PICU。
所有年龄在 6 个月至 18 岁之间（n=350）、疑似或确诊为脓毒症的患者均符合纳入条件。排除标准为 PICU 住院时间少于 8 小时以及可能影响血清铁蛋白水平的遗传性或获得性铁代谢紊乱。
无。
312 名患者在入院 48 小时内测量了铁蛋白水平，而有 38 名患者没有测量。缺铁性贫血（血红蛋白<11g/dL 和平均红细胞体积<80fl）的患病率为 40.3%。入院 48 小时内最高血清铁蛋白水平的中位数为 150.5ng/mL（四分位距，82.25-362ng/mL），与死亡率相关（p<0.001；Exp（B），5.170；95%CI，2.619-10.205）。铁蛋白水平增加 10 倍，死亡率增加 5 倍。随着铁蛋白水平的升高，死亡率呈单调递增趋势（p<0.05）。关于铁蛋白对死亡率的判别能力，受试者工作特征曲线下面积为 0.787（95%CI，0.737-0.83；p<0.0001）。
在一个缺铁性贫血患病率较高的中等收入国家，入院时血清铁蛋白水平较低预测 ICU 内脓毒症儿童的死亡率。
