Cardiac Dysfunction and Serum Ferritin Level as Early Prognostic Markers in Children with Sepsis: A Cross-sectional Study

Abstract

Background: Sepsis still causes morbidity and mortality in children admitted to the pediatric intensive care unit (PICU). Sepsis induces myocardial dysfunction and causes a reversible decline in ejection fraction (EF) of ventricles. Many biomarkers have been described for diagnosing sepsis, including serum ferritin and C-reactive protein (CRP). Objectives: This study was conducted to assess the relationship of cardiac dysfunction evaluated using echocardiogram, ferritin, and CRP with negative outcomes of sepsis in the PICU. Methods: A cross-sectional study was conducted on 80 patients aged between one month and six years who fulfilled the following criteria: (1) confirmed diagnosis of sepsis according to the American College of Critical Care Medicine; (2) receiving ventilation for 48 h and/or vasoactive medicines. The CRP and ferritin levels were recorded on the first day (D1) and third day (D3) of hospitalization in the PICU. Participants underwent an echocardiography study to investigate the ejection fraction on D1 and D3. All outcomes were evaluated. Results: Our results showed a highly statistically significant difference between D1 and D3 in ejection fraction (P = 0.001). The serum ferritin level and CRP enhanced significantly from D1 to D3 (P < 0.001). Low left ventricular ejection fraction, and high serum ferritin were associated with unfavorable outcomes (P values < 0.001 and 0.021, respectively), but there was no significant difference in the outcomes regarding CRP. Conclusions: Cardiac dysfunction and high serum ferritin were associated with unfavorable outcomes in children with sepsis admitted to the PICU.