Mortality Risk in Pediatric Sepsis Based on C-reactive Protein and Ferritin Levels.

TitleMortality Risk in Pediatric Sepsis Based on C-reactive Protein and Ferritin Levels.
Publication TypeJournal Article
Year of Publication2022
AuthorsHorvat, CM, Fabio, A, Nagin, DS, Banks, RK, Qin, Y, Park, H-J, Kernan, KF, Canna, SW, Berg, RA, Wessel, D, Pollack, MM, Meert, K, Hall, M, Newth, C, Lin, JC, Doctor, A, Shanley, T, Cornell, T, Harrison, RE, Zuppa, AF, Reeder, RW, Sward, K, Holubkov, R, Notterman, DA, J Dean, M, Carcillo, JA
Corporate Authors
JournalPediatr Crit Care Med
Volume23
Issue12
Pagination968-979
Date Published2022 Dec 01
ISSN1529-7535
Abstract

<p><b>OBJECTIVES: </b>Interest in using bedside C-reactive protein (CRP) and ferritin levels to identify patients with hyperinflammatory sepsis who might benefit from anti-inflammatory therapies has piqued with the COVID-19 pandemic experience. Our first objective was to identify patterns in CRP and ferritin trajectory among critically ill pediatric sepsis patients. We then examined the association between these different groups of patients in their inflammatory cytokine responses, systemic inflammation, and mortality risks.</p><p><b>DATA SOURCES: </b>A prospective, observational cohort study.</p><p><b>STUDY SELECTION: </b>Children with sepsis and organ failure in nine pediatric intensive care units in the United States.</p><p><b>DATA EXTRACTION: </b>Two hundred and fifty-five children were enrolled. Five distinct clinical multi-trajectory groups were identified. Plasma CRP (mg/dL), ferritin (ng/mL), and 31 cytokine levels were measured at two timepoints during sepsis (median Day 2 and Day 5). Group-based multi-trajectory models (GBMTM) identified groups of children with distinct patterns of CRP and ferritin.</p><p><b>DATA SYNTHESIS: </b>Group 1 had normal CRP and ferritin levels ( n = 8; 0% mortality); Group 2 had high CRP levels that became normal, with normal ferritin levels throughout ( n = 80; 5% mortality); Group 3 had high ferritin levels alone ( n = 16; 6% mortality); Group 4 had very high CRP levels, and high ferritin levels ( n = 121; 11% mortality); and Group 5 had very high CRP and very high ferritin levels ( n = 30; 40% mortality). Cytokine responses differed across the five groups, with ferritin levels correlated with macrophage inflammatory protein 1α levels and CRP levels reflective of many cytokines.</p><p><b>CONCLUSIONS: </b>Bedside CRP and ferritin levels can be used together to distinguish groups of children with sepsis who have different systemic inflammation cytokine responses and mortality risks. These data suggest future potential value in personalized clinical trials with specific targets for anti-inflammatory therapies.</p>

DOI10.1097/PCC.0000000000003074
Alternate JournalPediatr Crit Care Med
PubMed ID36178701
Grant ListR01 HD098428 / HD / NICHD NIH HHS / United States