A Systemic Inflammation Mortality Risk Assessment Contingency Table for Severe Sepsis*. Issue 2 (February 2017)

• Record Type: Journal Article
• Authors: Carcillo, Joseph A.; Sward, Katherine; Halstead, E. Scott; Telford, Russell; Jimenez-Bacardi, Adria; Shakoory, Bita; Simon, Dennis; Hall, Mark
• Is Part Of: Pediatric critical care medicine. Volume 18:Issue 2(2017)
• Publication Date: 2017-02
• Subjects: C-reactive protein -- ferritin -- immunoparalysis -- macrophage activation syndrome -- multiple organ failure; Pediatric intensive care -- Periodicals; Pediatric emergencies -- Periodicals; 618.05
• DOI: 10.1097/PCC.0000000000001029
• Languages: English
• ISSNs: 1529-7535

Abstract

Abstract : Objectives: We tested the hypothesis that a C -reactive protein and ferritin-based systemic inflammation contingency table can track mortality risk in pediatric severe sepsis. Design: Prospective cohort study. Setting: Tertiary PICU. Patients: Children with 100 separate admission episodes of severe sepsis were enrolled. Interventions: Blood samples were attained on day 2 of sepsis and bi-weekly for biomarker batch analysis. A 2 × 2 contingency table using C -reactive protein and ferritin thresholds was developed. Measurements and Main Results: A C -reactive protein of 4.08 mg/dL and a ferritin of 1, 980 ng/mL were found to be optimal cutoffs for outcome prediction at first sampling ( n = 100) using the Youden index. PICU mortality was increased in the "high-risk" C -reactive protein greater than or equal to 4.08 mg/dL and ferritin greater than or equal to 1, 980 ng/mL category (6/13 [46.15%]) compared with the "intermediate-risk" C -reactive protein greater than or equal to 4.08 mg/dL and ferritin less than 1, 980 ng/mL or C -reactive protein less than 4.08 mg/dL and ferritin greater than or equal to 1, 980 ng/mL categories (2/43 [4.65%]), and the "low-risk" C -reactive protein less than 4.08 mg/dL and ferritin less than 1, 980 ng/mL category (0/44 [0%]) (odds ratio, 36.43 [95% CI, 6.16–215.21]). The high-risk category was also associated with the development of immunoparalysis (odds ratio, 4.47 [95% CI, 1.34–14.96]) and macrophage activation syndrome (odds ratio, 24.20 [95% CI, 5.50–106.54]). Sixty-three children underwent sequential blood sampling; those who were initially in the low-risk category ( n = 24) and those who subsequently migrated ( n = 19) to the low-risk category all survived, whereas those who remained in the "at-risk" categories had increased mortality (7/20 [35%]; p < 0.05). Conclusions: A C -reactive protein- and ferritin-based contingency table effectively assessed mortality risk. Reduction in systemic inflammation below a combined threshold C -reactive protein of 4.08 mg/dL and ferritin of 1, 980 ng/mL appeared to be a desired response in children with severe sepsis. Abstract : Supplemental Digital Content is available in the text.