Pai Kirti, Angurana Suresh Kumar, Nallasamy Karthi, Muralidharan Jayashree, Bhatia Prateek, Rawat Amit
From the Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Division of Pediatric Hemato-oncology, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Pediatr Infect Dis J. 2025 Jul 15. doi: 10.1097/INF.0000000000004916.
To determine the serum ferritin levels, single-center prevalence of hyperferritinemia and its association with mortality in critically ill children with severe sepsis.
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.
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).
Hyperferritinemia was common in critically ill children with severe sepsis and was significantly associated with mortality.
确定重症脓毒症患儿的血清铁蛋白水平、单中心高铁蛋白血症患病率及其与死亡率的关联。
这项前瞻性研究在印度北部一家三级护理教学医院的儿科重症监护病房进行，为期13个月（2023年6月至2024年6月），纳入3个月至12岁的重症脓毒症患儿。入院时采集血液以评估血清铁蛋白水平。高铁蛋白血症定义为铁蛋白水平>500 ng/mL。主要结局是确定血清铁蛋白与死亡率之间的关联；次要结局包括血清铁蛋白水平评估、单中心高铁蛋白血症患病率、预测死亡率的血清铁蛋白最佳临界值以及血清铁蛋白与严重程度评分的相关性。
我们纳入了115名儿童，中位（四分位间距）年龄为3（1 - 7）岁。常见诊断包括社区获得性肺炎（39.1%）、恙虫病（13.9%）、中枢神经系统感染（10.4%）、多系统病毒感染（10.4%）、登革热（9.6%）、胃肠道脓毒症（6.1%）和播散性葡萄球菌脓毒症（4.3%）。中位（四分位间距）血清铁蛋白水平为550（233 - 1633）ng/mL，52%（n = 60）患有高铁蛋白血症。与幸存者相比，非幸存者的血清铁蛋白水平显著更高[1355（860 - 4435）对233（108 - 306），P = 0.01]。高铁蛋白血症患儿的死亡率显著更高（38.3%对16.4%，P = 0.012）。预测死亡率的血清铁蛋白最佳临界值为705 ng/mL（曲线下面积[AUC]：0.653，敏感性和特异性均为63%，P = 0.011）。高铁蛋白血症患儿的病程更长，器官功能障碍（凝血功能障碍、肝功能障碍、休克、急性呼吸窘迫综合征和急性肾损伤）的发生率更高。血清铁蛋白与儿科死亡风险III评分呈正相关（ρ = 0.342，P = 0.001）、第2天（ρ = 0.204，P = 0.042）和第5天（ρ = 0.235，P = 0.046）的儿科逻辑器官功能障碍 - 2评分以及第1天的血管活性药物评分呈正相关（ρ = 0.305，P = 0.033）。
高铁蛋白血症在重症脓毒症患儿中很常见，且与死亡率显著相关。
