Mối liên quan giữa nồng độ ferritin huyết thanh và tử vong ở trẻ em mắc sốc nhiễm trùng

Septic shock in children remains a critical global health concern, characterized by high morbidity and mortality, particularly in low-resource settings like Vietnam. Early identification of high-risk patients is crucial for implementing timely and effective interventions. While ferritin is primarily known as an iron-storage protein, its role as an acute phase reactant and a marker of systemic inflammation has gained increasing attention. Elevated ferritin huyết thanh levels have been linked to adverse outcomes in severe infections. However, the precise prognostic value of ferritin in pediatric sốc nhiễm trùng in the Vietnamese context remains underexplored. This study aims to evaluate the correlation between serum ferritin levels and tử vong in pediatric patients, shedding light on its potential as an accessible and cost-effective prognostic biomarker in clinical practice for trẻ em.

Bác sĩ nhi khoa, bác sĩ hồi sức tích cực, bác sĩ cấp cứu, và các nhà nghiên cứu trong lĩnh vực nhi khoa và bệnh truyền nhiễm.

This descriptive cross-sectional study investigated the relationship between ferritin huyết thanh levels and mortality in 114 children aged 1 month to 16 years diagnosed with sốc nhiễm trùng admitted to the Pediatric Intensive Care Unit at the National Hospital of Pediatrics in Vietnam between March and November 2023. The methodology involved collecting serum ferritin levels within 24 hours of admission and analyzing their correlation with various severity scores and patient outcomes, including tử vong. The findings revealed significantly higher median ferritin levels in the mortality group (1899.5 ng/mL) compared to survivors (176.0 ng/mL). A ferritin cut-off value greater than 1369.5 ng/mL demonstrated a good predictive ability for mortality, with an Area Under the Curve (AUC) of 0.77, and was identified as an independent prognostic factor. Furthermore, serum ferritin levels exhibited significant positive correlations with established severity scores such as PRISM-III, pSOFA, VIS, and Lactate, indicating its utility as a marker for disease severity. The study posits that the increased ferritin observed in septic shock is an acute inflammatory response, mediated by macrophage activation and cytokines, contributing to a vicious cycle of inflammation and worse prognosis. The clinical implication is that ferritin huyết thanh, being a readily available and cost-effective biomarker, can serve as a valuable tool for early risk stratification and guiding therapeutic decisions in pediatric septic shock. Identifying trẻ em with elevated ferritin early could prompt more aggressive management, potentially reducing tử vong. While confirming ferritin's role as a prognostic indicator in this specific population, the authors suggest the need for larger, multi-center, and longitudinal studies to further validate its dynamic changes and optimize its integration into clinical guidelines for pediatric critical care.