Cristian T Tonial1, Caroline A D Costa2, Gabriela R H Andrades2, Francielly Crestani2, Paulo R Einloft1, Francisco Bruno1, Ana P Miranda1, Humberto H Fiori3, Pedro Celiny R Garcia4. 1. 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. 2. 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. 3. Department of Pediatrics, Post-graduate Program in Pediatrics and Child Health, School of Medicine and Neonatal Intensive Care of Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil. 4. Department of Pediatrics, 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), Research Fellow of the Brazilian Council for Scientific and Technological Development (CNPq), Porto Alegre, Rio Grande do Sul, Brazil.
Abstract
OBJECTIVES: 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. DESIGN: Retrospective cohort study. SETTING: PICU of a tertiary care teaching hospital in a middle-income country in South America. PATIENTS: 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. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: 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). CONCLUSIONS: 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.
OBJECTIVES: 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. DESIGN: Retrospective cohort study. SETTING: PICU of a tertiary care teaching hospital in a middle-income country in South America. PATIENTS: 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. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: 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). CONCLUSIONS: 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.
Authors: Joseph A Carcillo; Kate K Kernan; Christopher M Horvat; Dennis W Simon; Rajesh K Aneja Journal: Pediatr Crit Care Med Date: 2020-05 Impact factor: 3.624
Authors: Kusum Menon; Luregn J Schlapbach; Samuel Akech; Andrew Argent; Paolo Biban; Enitan D Carrol; Kathleen Chiotos; Mohammod Jobayer Chisti; Idris V R Evans; David P Inwald; Paul Ishimine; Niranjan Kissoon; Rakesh Lodha; Simon Nadel; Cláudio Flauzino Oliveira; Mark Peters; Benham Sadeghirad; Halden F Scott; Daniela C de Souza; Pierre Tissieres; R Scott Watson; Matthew O Wiens; James L Wynn; Jerry J Zimmerman; Lauren R Sorce Journal: Crit Care Med Date: 2022-01-01 Impact factor: 9.296