12. Mối liên quan giữa nồng độ Ferritin huyết thanh và tử vong ở trẻ em mắc sốc nhiễm trùng
Nội dung chính của bài viết
Tóm tắt
Nghiên cứu mô tả tiến cứu trên 114 trẻ sốc nhiễm trùng tại Khoa Điều trị tích cực nội khoa (PICU)- Bệnh viện Nhi Trung ương, từ tháng 3 đến tháng 11/2023 để xác định mối liên quan giữa nồng độ ferritin huyết thanh và tử vong ở trẻ em mắc sốc nhiễm trùng. Nồng độ ferritin tăng cao ở trẻ sốc nhiễm trùng, với trung vị là 642,0 ng/mL (IQR: 339,0 - 1976,8), nồng độ ferritin huyết thanh ở nhóm tử vong là 1899,5 ng/mL (IQR: 934,5 - 4278,8), cao hơn so với nhóm sống sót (176,0 ng/mL, IQR: 101,4 - 5289,5). Đường cong ROC của ferritin dự đoán tử vong cho thấy diện tích dưới đường cong (AUC) là 0,77 ( 95% CI: 0,67 - 0,88). Có mối tương quan thuận giữa nồng độ ferritin với: điểm PRISM-III (r = 0,46, p < 0,0001), điểm pSOFA (r = 0,51, p < 0,0001), Lactate (r = 0,3, p = 0,001), VIS tối đa (r = 0,38, p < 0,0001). Ngưỡng cut-off của Ferritin > 1369,5 ng/mL có giá trị tiên lượng độc lập và nên được sử dụng trong mô hình dự đoán tử vong.
Chi tiết bài viết
Từ khóa
Ferritin huyết thanh, sốc nhiễm trùng, tử vong, trẻ em
Tài liệu tham khảo
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2. Kernan KF, Carcillo JA. Hyperferritinemia and inflammation. Int Immunol. 2017; 29(9): 401-409. doi:10.1093/intimm/dxx031. https://academic.oup.com/intimm/article/29/9/401/3852570.
3. Garcia PCR, Longhi F, Branco RG, Piva JP, Lacks D, Tasker RC. Ferritin levels in children with severe sepsis and septic shock. Acta Paediatr. 2007; 96(12): 1829-1831. doi:10.1111/j.1651-2227.2007.00564.x. https://onlinelibrary.wiley.com/doi/10.1111/j.1651-2227.2007.00564.x
4. Tonial CT, Costa CAD, Andrades GRH, et al. Prediction of Poor Outcomes for Septic Children According to Ferritin Levels in a Middle-Income Setting. Pediatr Crit Care Med. 2020; 21(5): e259-e266. doi:10.1097/PCC.0000000000002273. https://journals.lww.com/pccmjournal/abstract/2020/05000/prediction_of_poor_outcomes_for_septic_children.28.aspx.
5. Ghosh S, Baranwal AK, Bhatia P, Nallasamy K. Suspecting Hyperferritinemic Sepsis in Iron-Deficient Population: Do We Need a Lower Plasma Ferritin Threshold? Pediatr Crit Care Med. 2018; 19(7): e367-e373. doi:10.1097/PCC.0000000000001584. https://journals.lww.com/pccmjournal/abstract/2018/07000/suspecting_hyperferritinemic_sepsis_in.31.aspx.
6. Horvat CM, Fabio A, Nagin DS, et al. Mortality Risk in Pediatric Sepsis Based on C-reactive Protein and Ferritin Levels. Pediatr Crit Care Med. 2022; 23(12): 968-979. doi:10.1097/PCC.0000000000003074 https://journals.lww.com/pccmjournal/abstract/2022/12000/mortality_risk_in_pediatric_sepsis_based_on.3.aspx.
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8. Davis AL, Carcillo JA, Aneja RK, et al. American College of Critical Care Medicine Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock. Crit Care Med. 2017; 45(6): 1061-1093. doi:10.1097/CCM.0000000000002425. https://journals.lww.com/ccmjournal/fulltext/2017/06000/american_college_of_critical_care_medicine.18.aspx.
9. Điển, T. M., & Lê Nam Trà, P. V. T. (2012). Sốc nhiễm khuẩn trẻ em. Tạp chí Nhi khoa, 5(4), 1-16. khuẩn.
10. Tạ AT, Nguyễn TTH. Mối liên quan giữa rối loạn đông cầm máu và suy chức năng đa cơ quan trên bệnh nhi sốc nhiễm trùng tại khoa Điều trị tích cực nội, Bệnh viện Nhi Trung ương. VMJ. 2021; 504(2). doi:10.51298/vmj.v504i2.926. https://tapchiyhocvietnam.vn/index.php/vmj/article/view/926.
11. Vincent JL, Beumier M. Diagnostic and prognostic markers in sepsis. Expert Rev Anti Infect Ther. 2013; 11(3): 265-275. doi:10.1586/eri.13.9. https://www.tandfonline.com/doi/abs/10.1586/eri.13.9.
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13. Azad N, Pradhan P. Guidelines for control of iron deficiency anaemia. In: ; 2013. Accessed March 3, 2025. https://www.semanticscholar.org/paper/Guidelines-for-control-of-iron-deficiency-anaemia-Azad-Pradhan/bb940be553e954f07579550d2e6edfbb0ebd7b52.
14. Tonial CT, Garcia PCR, Schweitzer LC, et al. Cardiac dysfunction and ferritin as early markers of severity in pediatric sepsis. J Pediatr (Rio J). 2017; 93(3): 301-307. doi:10.1016/j.jped.2016.08.006. https://www.sciencedirect.com/science/article/pii/S0021755717300323.
15. Gupta PM, Hamner HC, Suchdev PS, Flores-Ayala R, Mei Z. Iron status of toddlers, nonpregnant females, and pregnant females in the United States. Am J Clin Nutr. 2017; 106(Suppl 6): 1640S-1646S. doi:10.3945/ajcn.117.155978. https://www.sciencedirect.com/science/article/pii/S0002916522027368.
16. Carcillo JA, Sward K, Halstead ES, et al. A Systemic Inflammation Mortality Risk Assessment Contingency Table for Severe Sepsis. Pediatr Crit Care Med. 2017; 18(2): 143-150. doi:10.1097/PCC.0000000000001029. https://journals.lww.com/pccmjournal/abstract/2017/02000/a_systemic_inflammation_mortality_risk_assessment.6.aspx.
17. Zarjou A, Black LM, McCullough KR, et al. Ferritin Light Chain Confers Protection Against Sepsis-Induced Inflammation and Organ Injury. Front Immunol. 2019; 10: 131. doi:10.3389/fimmu.2019.00131. https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2019.00131/full.
18. Cullis JO, Fitzsimons EJ, Griffiths WJ, Tsochatzis E, Thomas DW, British Society for Haematology. Investigation and management of a raised serum ferritin. Br J Haematol. 2018; 181(3): 331-340. doi:10.1111/bjh.15166. https://onlinelibrary.wiley.com/doi/full/10.1111/bjh.15166.
19. McWilliam S, Riordan A. How to use: C-reactive protein. Arch Dis Child Educ Pract Ed. 2010; 95(2): 55-58. doi:10.1136/adc.2009.174367. https://ep.bmj.com/content/95/2/55.
2. Kernan KF, Carcillo JA. Hyperferritinemia and inflammation. Int Immunol. 2017; 29(9): 401-409. doi:10.1093/intimm/dxx031. https://academic.oup.com/intimm/article/29/9/401/3852570.
3. Garcia PCR, Longhi F, Branco RG, Piva JP, Lacks D, Tasker RC. Ferritin levels in children with severe sepsis and septic shock. Acta Paediatr. 2007; 96(12): 1829-1831. doi:10.1111/j.1651-2227.2007.00564.x. https://onlinelibrary.wiley.com/doi/10.1111/j.1651-2227.2007.00564.x
4. Tonial CT, Costa CAD, Andrades GRH, et al. Prediction of Poor Outcomes for Septic Children According to Ferritin Levels in a Middle-Income Setting. Pediatr Crit Care Med. 2020; 21(5): e259-e266. doi:10.1097/PCC.0000000000002273. https://journals.lww.com/pccmjournal/abstract/2020/05000/prediction_of_poor_outcomes_for_septic_children.28.aspx.
5. Ghosh S, Baranwal AK, Bhatia P, Nallasamy K. Suspecting Hyperferritinemic Sepsis in Iron-Deficient Population: Do We Need a Lower Plasma Ferritin Threshold? Pediatr Crit Care Med. 2018; 19(7): e367-e373. doi:10.1097/PCC.0000000000001584. https://journals.lww.com/pccmjournal/abstract/2018/07000/suspecting_hyperferritinemic_sepsis_in.31.aspx.
6. Horvat CM, Fabio A, Nagin DS, et al. Mortality Risk in Pediatric Sepsis Based on C-reactive Protein and Ferritin Levels. Pediatr Crit Care Med. 2022; 23(12): 968-979. doi:10.1097/PCC.0000000000003074 https://journals.lww.com/pccmjournal/abstract/2022/12000/mortality_risk_in_pediatric_sepsis_based_on.3.aspx.
7. Weiss SL, Peters MJ, Alhazzani W, et al. Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children. Pediatr Crit Care Med. 2020; 21(2): e52-e106. doi:10.1097/PCC.0000000000002198. https://journals.lww.com/pccmjournal/fulltext/2020/02000/surviving_sepsis_campaign_international_guidelines.20.aspx.
8. Davis AL, Carcillo JA, Aneja RK, et al. American College of Critical Care Medicine Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock. Crit Care Med. 2017; 45(6): 1061-1093. doi:10.1097/CCM.0000000000002425. https://journals.lww.com/ccmjournal/fulltext/2017/06000/american_college_of_critical_care_medicine.18.aspx.
9. Điển, T. M., & Lê Nam Trà, P. V. T. (2012). Sốc nhiễm khuẩn trẻ em. Tạp chí Nhi khoa, 5(4), 1-16. khuẩn.
10. Tạ AT, Nguyễn TTH. Mối liên quan giữa rối loạn đông cầm máu và suy chức năng đa cơ quan trên bệnh nhi sốc nhiễm trùng tại khoa Điều trị tích cực nội, Bệnh viện Nhi Trung ương. VMJ. 2021; 504(2). doi:10.51298/vmj.v504i2.926. https://tapchiyhocvietnam.vn/index.php/vmj/article/view/926.
11. Vincent JL, Beumier M. Diagnostic and prognostic markers in sepsis. Expert Rev Anti Infect Ther. 2013; 11(3): 265-275. doi:10.1586/eri.13.9. https://www.tandfonline.com/doi/abs/10.1586/eri.13.9.
12. Goldstein B, Giroir B, Randolph A, International Consensus Conference on Pediatric Sepsis. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med. 2005; 6(1): 2-8. doi:10.1097/01.PCC.0000149131.72248.E6. https://journals.lww.com/pccmjournal/abstract/2005/01000/international_pediatric_sepsis_consensus.2.aspx.
13. Azad N, Pradhan P. Guidelines for control of iron deficiency anaemia. In: ; 2013. Accessed March 3, 2025. https://www.semanticscholar.org/paper/Guidelines-for-control-of-iron-deficiency-anaemia-Azad-Pradhan/bb940be553e954f07579550d2e6edfbb0ebd7b52.
14. Tonial CT, Garcia PCR, Schweitzer LC, et al. Cardiac dysfunction and ferritin as early markers of severity in pediatric sepsis. J Pediatr (Rio J). 2017; 93(3): 301-307. doi:10.1016/j.jped.2016.08.006. https://www.sciencedirect.com/science/article/pii/S0021755717300323.
15. Gupta PM, Hamner HC, Suchdev PS, Flores-Ayala R, Mei Z. Iron status of toddlers, nonpregnant females, and pregnant females in the United States. Am J Clin Nutr. 2017; 106(Suppl 6): 1640S-1646S. doi:10.3945/ajcn.117.155978. https://www.sciencedirect.com/science/article/pii/S0002916522027368.
16. Carcillo JA, Sward K, Halstead ES, et al. A Systemic Inflammation Mortality Risk Assessment Contingency Table for Severe Sepsis. Pediatr Crit Care Med. 2017; 18(2): 143-150. doi:10.1097/PCC.0000000000001029. https://journals.lww.com/pccmjournal/abstract/2017/02000/a_systemic_inflammation_mortality_risk_assessment.6.aspx.
17. Zarjou A, Black LM, McCullough KR, et al. Ferritin Light Chain Confers Protection Against Sepsis-Induced Inflammation and Organ Injury. Front Immunol. 2019; 10: 131. doi:10.3389/fimmu.2019.00131. https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2019.00131/full.
18. Cullis JO, Fitzsimons EJ, Griffiths WJ, Tsochatzis E, Thomas DW, British Society for Haematology. Investigation and management of a raised serum ferritin. Br J Haematol. 2018; 181(3): 331-340. doi:10.1111/bjh.15166. https://onlinelibrary.wiley.com/doi/full/10.1111/bjh.15166.
19. McWilliam S, Riordan A. How to use: C-reactive protein. Arch Dis Child Educ Pract Ed. 2010; 95(2): 55-58. doi:10.1136/adc.2009.174367. https://ep.bmj.com/content/95/2/55.