| Abstrakt: |
Background: Serum ferritin, in addition to representing body iron stores, is an acute-phase protein that increases in the presence of circulating inflammatory cytokines. When these mediators are stimulated, iron stored in the form of ferritin tends to increase while iron stored in the reticuloendothelial system tends to decrease. Ferritin is believed to be a serum marker of cellular damage and does not appear to produce deleterious effects. Elevated serum ferritin is associated with several inflammatory conditions, such as sepsis, multiorgan dysfunction syndrome (MODS), and Macrophage Activation Syndrome Methodology: This crosssectional study was conducted in Pediatric Intensive Care Unit, at Bharati Vidyapeeth (Deemed to be University) Medical College and Hospital Sangli, Maharashtra. All children from 2 months to 18 years of age who fulfills criteria of sepsis were included in the study. Informed consent will be taken. The study protocol was approved by Institutional Ethical Committee. Result: In the present study, thirty patients were included, among them raised Serum Ferritin was observed in 22(73.3%) patients. Among the total number of cases, SIRS was seen in 4 cases, Sepsis in 12 cases, Severe Sepsis in 5 cases and Septic Shock in 9 cases with means serum ferritin level of 419, 769, 747 and 811 respectively. Total of 5(16.7%) cases had 3 or more organ involvement. In comparison to males, females have 4 times more chance of mortality, but it is non significant. Patients on ventilator had 28.385 times more chance of mortality than patients who did not require ventilator support, and it is significant (p=0.01).In comparison to patients having PRISM III score <15, patients having PRISM III score >15 have 23.4 times more chance of mortality, and it is significant (p=0.02). Patients with ferritin >500 have 28.385 times more chance of mortality, and it is significant (0.01). Patients who required Ionotropic Support had 28.385 times more chance of mortality, and it is significant (0.01). Mean ferritin level value in overall is 731.8(84-2982)ng/mL and it was significantly higher in non survivors (1556) as compared to survivors (605.04) (p=0.03). Sr. Ferritin >500 had: Sensitivity of 1.00 (95% Confidence Interval 0.40-1.00) and Specificity of 0.76 (95% Confidence Interval 0.56-0.91). Chi square test was done to compare between Sr ferritin level and survivors. It was found that all non survivors were having Sr ferritin level >500. Unpaired t test was done to compare PRISM III score, Duration of Mechanical Ventilator(days) and Length of PICU stay(days) and no significant difference in comparison to Sr ferritin level was found. Conclusion: This study shows that Sr Ferritin is raised in children with sepsis and high Ferritin level(>500ng/mL) is associated with poorer outcome. It is one of the useful biomarker of predictor of mortality. Serum Ferritin can be useful to predict poor outcome in children with sepsis. [ABSTRACT FROM AUTHOR] |
