Relationship between serum ferritin level and outcome of septic shock in children

Background Sepsis is a life-threatening organ dysfunction caused by dysregulation of the immune system against infection. Sepsis that leads to septic shock is one of the causes of morbidity and mortality in children who are treated in intensive care and inpatient rooms. Ferritin is a protein whose synthesis is increased in inflammatory and infectious conditions and can be a marker of active infection. The cut off ferritin in septic shock was not established and not absolutely clear in our patients.

Objective To determine the cut-off value of ferritin levels in patient with septic shock and the relationship between high serum ferritin levels with poor outcome (mortality) in pediatric patients with septic shock.

Methods This study used an observational-analytic design with prospective cohort study design. The research was conducted in pediatric ward, Prof. Dr. I.G.N.G. Ngoerah hospital from October 2021 to August 2022. Data analysis was done in 2 steps, first by using receiver operator characteristic curves to find the optimal cut-off point value and the second step was bivariate and multivariate analysis to determine the relationship between ferritin levels and the outcome of septic shock in children. The significance level (α) of this study was set with probability value less than 0.05.

Results This study involved 76 subjects, 49 subjects died and 27 subjects survive. The Area Under Curve of ferritin levels from ROC curve obtained was ​​83.7% (p=0.001, 95% CI 74.2%-93.1%). The cut off for ferritin level 660.78 ng/ml gave sensitivity 85.7% and specificity 77.8% for mortality in patients with septic shock. The value of ferritin levels ³ 660.78 generate mortality risk 39.50 times (95% CI 8.057 – 183.422) in pediatric patients with septic shock.

Conclusion Higher ferritin levels can increase the risk of mortality in pediatric septic shock patients.