Abstract
Background:
Hyperferritinemia is increasingly recognized as a marker of inflammation and severity in sepsis. This study aimed to ascertain the level of ferritin as predictor of septic shock and its association with outcome.
Methods:
A prospective observational study was conducted on 123 children diagnosed with severe sepsis and septic shock at a tertiary care hospital of North India. Serum ferritin levels were measured, with hyperferritinemia defined as levels >500 ng/mL[Henter et.al]. In our study good outcome was defined as discharge or improving clinical status and bad outcome was defined as death, or clinical deterioration . The association of hyperferritinemia with septic shock and clinical outcomes was analyzed and statistically evaluated. Analysis of the area under the curve (AUC) and ROC curve was constructed to assess the predictive strength of ferritin as marker of septic shock. Sensitivity, specificity, positive and negative likelihood ratio were calculated at different cut off values of serum ferritin
Results:
Hyperferritinemia was found in 66.6% of patients, with significantly higher levels in septic shock (1624.67 ± 1522.02 ng/mL) than sepsis (727.02 ± 1081.12 ng/mL, p=0.005). Hyperferritinemia (serum ferritin ≥730 ng/mL) was a predictor of septic shock (AUC=0.80, 95% CI=0.72-0.89, p value=0.02). Mortality was higher in patients with hyperferritenemia (OR=12.9, 95%CI=1.67-99.90, p value=0.001). Serum ferritin at level of 2214 ng/ml was found to be predictive of secondary HLH with sensitivity of 100% and specificity of 94.8%.
Conclusion:
Hyperferritinemia is prevalent in pediatric sepsis and septic shock and is significantly associated with higher mortality. Serum ferritin may serve as a potential prognostic marker for identifying high-risk patients.

Key words: Hyperferritinemia, Sepsis, Septic Shock, Ferritin, outcome