A Systemic Inflammation Mortality Risk Assessment Contingency Table for Severe Sepsis

被引:72
作者
Carcillo, Joseph A. [1 ]
Sward, Katherine [2 ]
Halstead, E. Scott [1 ]
Telford, Russell [2 ]
Jimenez-Bacardi, Adria [1 ]
Shakoory, Bita [3 ]
Simon, Dennis [1 ]
Hall, Mark [4 ]
机构
[1] Childrens Hosp Pittsburgh, Dept Crit Care Med & Pediat, Pittsburgh, PA 15213 USA
[2] Primary Childrens Med Ctr, Dept Pediat, Salt Lake City, UT USA
[3] George Washington Univ, Dept Med, Washington, DC USA
[4] Nationwide Childrens Hosp, Dept Pediat, Columbus, OH USA
基金
美国国家卫生研究院;
关键词
C-reactive protein; ferritin; immunoparalysis; macrophage activation syndrome; multiple organ failure; C-REACTIVE PROTEIN; SYNDROME/MACROPHAGE ACTIVATION SYNDROME; LYMPHOCYTE APOPTOSIS; ORGAN FAILURE; IMMUNOPARALYSIS; MULTICENTER; CHILDREN; FEATURES; OUTCOMES; CARE;
D O I
10.1097/PCC.0000000000001029
中图分类号
R4 [临床医学];
学科分类号
100218 [急诊医学];
摘要
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 x 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.
引用
收藏
页码:143 / 150
页数:8
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