• Cristian T Tonial, Caroline A D Costa, Gabriela R H Andrades, Francielly Crestani, Paulo R Einloft, Francisco Bruno, Ana P Miranda, Humberto H Fiori, and Garcia Pedro Celiny R PCR Department of Pediatrics, Post-graduate Program in Pediatrics and Child Health, School of Medicine and Pediatric Intensive Care of Hospital São .
• Department of Pediatrics, School of Medicine and Pediatric Intensive Care of Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil.
• Pediatr Crit Care Me. 2020 May 1; 21 (5): e259-e266.

ObjectivesTo evaluate serum ferritin measured within 48 hours of admission as a prognostic marker and examine the association with unfavorable outcomes in a population of pediatric patients with sepsis and high prevalence of iron deficiency anemia in which this biomarker is routinely measured.DesignRetrospective cohort study.SettingPICU of a tertiary care teaching hospital in a middle-income country in South America.PatientsAll patients 6 months to 18 years old (n = 350) admitted with a diagnosis of sepsis, suspected or proven, were eligible for inclusion. Exclusion criteria were length of PICU stay less than 8 hours and inherited or acquired disorder of iron metabolism that could interfere with serum ferritin levels.InterventionsNone.Measurements And Main ResultsThree-hundred twelve patients had their ferritin levels measured within 48 hours, and only 38 did not. The prevalence of iron deficiency anemia (hemoglobin < 11 g/dL and mean corpuscular volume < 80 fl was 40.3%. The median of the highest serum ferritin level within 48 hours was 150.5 ng/mL (interquartile range, 82.25-362 ng/mL), being associated with mortality (p < 0.001; Exp(B), 5.170; 95% CI, 2.619-10.205). A 10-fold increase in ferritin level was associated with a five-fold increase in mortality. There was a monotonic increase in mortality with increasing ferritin levels (p < 0.05). Regarding the discriminatory power of ferritin for mortality, the area under the receiver operating characteristic curve was 0.787 (95% CI, 0.737-0.83; p < 0.0001).ConclusionsSerum ferritin at lower thresholds predicts mortality in children with sepsis admitted to the ICU in a middle-income country with high prevalence of iron deficiency anemia.

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