Objective: To evaluate serial
ferritin levels measured in the initial 72 h of admission as a
biomarker for new and progressive multi organ dysfunction syndrome (NPMODS) and mortality (unfavorable outcomes) in
critically ill children with
sepsis due to tropical
infections. Material and Methods: In this prospective observational study from a tertiary care teaching hospital in India, children 3 month to 12 years with a diagnosis of acute febrile illness and any two features suggesting tropical
infections [
cytopenia (platelet count <1,00,000/cu.mm, total leucocyte count <4,000/cu.mm),
hepatomegaly and/or
splenomegaly,
lymphadenopathy, systemic signs (
rash,
edema), respiratory distress, and
encephalopathy not accounted by localized
infection] were eligible for inclusion. Children with known or suspected disorder of
iron metabolism were excluded. Primary outcome was to determine the association of serial
ferritin levels with mortality and NPMODS. Secondary outcomes included estimation of the prevalence of
hyperferritinemia and comparison of risk prediction scores with serial
ferritin measurement in predicting unfavorable outcomes. Measurements and Main Results: In the 202 children enrolled, diagnosis could be established in 133 (65.8%) children.
Scrub typhus and
dengue were the most common
infections. Median (IQR)
ferritin measured at admission (n = 183) and on day 3 (n = 120) of
hospital stay were 798 (378, 3,205) μg/L and 429 (213,680) μg/L, respectively. Majority (n = 180, 89.1%) had
MODS at admission defined as per International pediatric
sepsis consensus conference. NPMODS occurred in 47 (23.3%) children of whom 37 (18.3%) died. Children with three or less organ dysfunctions had lower mortality. Neither admission
ferritin values nor the percentage change over 72 h was different between children with favorable and unfavorable outcomes. Pediatric Risk of Mortality (PRISM-III) and daily Pediatric Logistic Organ Dysfunction score (dPELOD2 score) were significantly different in those with unfavorable outcomes. Admission
ferritin levels and percentage change in 72 h had poor discriminatory power for mortality with AUC of 0.53 (0.53, 0.67) and 0.50 (0.50, 0.64), respectively. dPELOD2 had the best discriminatory power for mortality with AUC of 0.89 (0.89, 0.95). Conclusions: Serial
ferritin estimation predicted neither organ dysfunction nor mortality in pediatric
sepsis with tropical
infections. dPELOD-2 and PRISM-III predicted unfavorable outcomes better than
ferritin. The current diagnostic criteria for
MODS overestimated organ dysfunctions in tropical
infections and hence may need modification with further validation in this epidemiological cohort.