Serum Ferritin Levels as a Prognostic Marker for Predicting Outcomes in Children With Severe Sepsis and Their Correlation With Pediatric Sequential Organ Failure Assessment Score.

backgroundSevere sepsis is associated with increased mortality in the pediatric population. Potential biomarkers, such as serum ferritin, may be helpful in the timely prognostication of severe sepsis. This study aimed to evaluate the prognostic ability of serum ferritin levels in children with severe sepsis. Additionally, the study also aimed to find the correlation between serum ferritin levels and the Pediatric Sequential Organ Failure Assessment (pSOFA) score in children with severe sepsis. METHODOLOGY: This study was conducted as an observational cross-sectional study on children admitted with severe sepsis to the pediatric intensive care unit (PICU) of a tertiary care center in Bhopal, India, over a period of 12 months. A total of 82 children aged between 1 month and 12 years who presented with severe sepsis were enrolled. Sepsis and severe sepsis were defined according to the 2005 International Pediatric Sepsis Definition Consensus criteria. The sociodemographic and clinical details of the study population were documented. Serum ferritin levels were measured within 24 hours of admission, and the pSOFA score was assessed twice, at 24 hours and 48 hours after admission, and the mean value was calculated. The final outcome was recorded in terms of survival and non-survival, and the results were compared between these two groups. Statistical analysis involved Pearson's correlation, receiver operating characteristic (ROC) curves, and logistic regression analysis.

resultsThe mean serum ferritin levels (849.55 ± 300.05 ng/mL vs. 398.45 ± 97.53 ng/mL) and pSOFA scores (13.50 ± 0.53 vs. 7.33 ± 2.31) were found to be significantly higher among non-survivors compared to survivors (p < 0.05). ROC curve analysis revealed good predictive ability of serum ferritin levels for mortality in children with severe sepsis. At a cut-off of >504 ng/mL, serum ferritin showed an area under the curve (AUC) of 0.992, with sensitivity of 100% and specificity of 84.3%. A significant correlation was found between serum ferritin levels and pSOFA score (r = 0.70 to 0.90; p < 0.05). At a cut-off of 12, the pSOFA score showed significant predictive ability for hyperferritinemia (>504 ng/mL), with an AUC of 0.901, sensitivity of 79.5%, and specificity of 100%. Logistic regression analysis documented serum ferritin levels and pSOFA score as independent markers of mortality. The risk of mortality was 8.3 times higher in patients with a mean pSOFA score >12. With respect to serum ferritin level, hyperferritinemia (>504 ng/mL) was associated with a 1.843 times higher risk of mortality.

conclusionHigh serum ferritin levels (>504 ng/mL) and pSOFA score >12 are both excellent and independent predictors of mortality in children with severe sepsis. A pSOFA score >12 has significant correlation with hyperferritinemia (serum ferritin >504 ng/mL). Incorporating these measurements in the care of children with severe sepsis may enhance risk stratification and support early intervention.