C-Reactive Protein and Ferritin Are Associated With Organ Dysfunction and Mortality in Hospitalized Children

Abstract

Our objective was to determine if C-reactive protein (CRP) and ferritin values alone and in combination are associated with mortality among hospitalized children. All hospitalized patients at our institution with a CRP or ferritin assay in 2015 and 2016 were included. Area under the receiver operating curves (AUROC) were examined, optimal cut-points determined, and patients were stratified into low-, intermediate-, or high-risk groups based on elevation of zero, one, or both biomarkers. A total of 14 928 CRP and 653 ferritin values were obtained, with both obtained for 172 patients. AUROC for maximum CRP value was 0.76 (0.68-0.85) with a cut-point of 7.1 mg/dL for in-hospital mortality and 0.90 (0.83-0.98) for maximum ferritin with a cut-point of 373 ng/mL. Elevation of both ferritin and CRP was associated with the highest inpatient mortality (21.7%) and greatest organ dysfunction, followed by either biomarker alone. Additional prospective study of these biomarkers in combination is warranted.

Ferritin and C-reactive protein are predictive biomarkers of mortality and macrophage activation syndrome in adult onset Still’s disease. Analysis of the multicentre Gruppo Italiano di Ricerca in Reumatologia Clinica e Sperimentale (GIRRCS) cohort

“…As far as CRP is concerned, paralleling what reported in systemic onset juvenile arthritis [ 23 ], we observed that higher CRP, at the time of diagnosis, predicted mortality during the follow-up. This result confirms what observed during infections and other inflammatory diseases, in which CRP correlates with organs failure and poor prognosis in patients admitted to intensive care units [ 42 – 44 ].…”

“…Although many biomarkers have been proposed in AOSD, many of these do not met the OMERACT criteria, especially considering the feasibility, which addresses the possibility to be easily and widely used. On the contrary, CRP, ESR, and ferritin are acute-phase reactants, certainly measurable worldwide, also in resource-limited settings, which correlate with the severity of different disorders, including infections and rheumatologic diseases [ 23 ]. On these bases, we performed a retrospective analysis of a large cohort of patients (more than 140) with AOSD, to investigate the role of ferritin, ESR, and CRP, at the time of diagnosis, in predicting disease-related mortality and MAS occurrence, during the following prospective follow-up.…”

Ferritin modifies the relationship between inflammation and arterial stiffness in hypertensive patients with different glucose tolerance

“…Considering that our study population presented a normal inflammation and iron status, it is also clinically plausible that ferritin per se might affect the increase in oxidative stress promoting those mechanisms that lead to vascular remodeling and increased arterial stiffness. Clinical practice supports this hypothesis, because ferritin represents a biomarker of disease progress and an independent predictor of various clinical outcome in different settings of patients [ 42 – 44 ]. Since the increase in carotid femoral PWV is associated with a significant risk increase for CV morbidity and mortality, we can speculate that the association between serum ferritin levels and PWV may be responsible for the negative prognostic effect of ferritin.…”

Serum Ferritin Predicts Neither Organ Dysfunction Nor Mortality in Pediatric Sepsis Due to Tropical Infections

“…Bennett et al in their single center retrospective study observed a stepwise increase in mortality risk in hospitalized children with ferritin ≥1,000 µg/L and ≥3,000 µg/L (13). Horvat et al (29) have found an association between ferritin levels and mortality using lower cutoff points (373 ng/mL), however the authors included all hospitalized children irrespective of sepsis diagnosis. In another recent large retrospective study by Tonial et al (16) in 312 children from Brazil, a LMIC setting similar to ours a lower cut off of 150 ng/ml was associated with mortality.…”