Abstract

Hyperferritinemia is increasingly recognized as a marker of inflammation and severity in sepsis. This study aimed to ascertain the level of ferritin as a predictor of septic shock (SS) and its association with outcome. A prospective observational study was conducted on 123 children diagnosed with severe sepsis and SS at a tertiary care hospital of North India. Serum ferritin levels were measured, with hyperferritinemia defined as levels >500 ng/ ml. Good outcome was defined as discharge or improving clinical status, and bad outcome was defined as death or clinical deterioration. The association of hyperferritinemia with SS and clinical outcomes was analyzed and statistically evaluated. Analysis of the area under the curve (AUC) and the receiver operating characteristic (ROC) curve was constructed to assess the predictive strength of ferritin as a marker of SS. Sensitivity, specificity, and positive and negative likelihood ratios were calculated at different cutoff values of serum ferritin. Hyperferritinemia was found in 66.6% of patients, with significantly higher levels in SS (1,624.67 ± 1,522.02 ng/ml) than sepsis (727.02 ± 1,081.12 ng/ml, p = 0.005). Hyperferritinemia (serum ferritin ≥ 730 ng/ml) was a predictor of SS (AUC = 0.80; 95% CI = 0.72–0.89; p value = 0.02). Mortality was higher in patients with hyperferritinemia (odd ratio = 12.9; 95% CI = 1.67–99.90; p value = 0.001). Serum ferritin at a level of 2,214 ng/ml was found to be predictive of secondary hemophagocytic lymphohistiocytosis (sensitivity of 100% and specificity of 94.8%). Hyperferritinemia is prevalent in pediatric sepsis and SS and is significantly associated with higher mortality. Serum ferritin may serve as a potential prognostic marker for identifying high-risk patients.

Key words: Hyperferritinemia, Sepsis, Septic Shock, Ferritin, outcome