title: Cardiac dysfunction and ferritin as early markers of severity in pediatric sepsis.
abstract: OBJECTIVE
  The aim of this study was to verify the association of echocardiogram, ferritin, C-reactive protein, and leukocyte count with unfavorable outcomes in pediatric sepsis.
  
  
  METHODS
  A prospective cohort study was carried out from March to December 2014, with pediatric critical care patients aged between 28 days and 18 years. Inclusion criteria were diagnosis of sepsis, need for mechanical ventilation for more than 48h, and vasoactive drugs. Serum levels of C-reactive protein, ferritin, and leukocyte count were collected on the first day (D0), 24h (D1), and 72h (D3) after recruitment. Patients underwent transthoracic echocardiography to determine the ejection fraction of the left ventricle on D1 and D3. The outcomes measured were length of hospital stay and in the pediatric intensive care unit, mechanical ventilation duration, free hours of VM, duration of use of inotropic agents, maximum inotropic score, and mortality.
  
  
  RESULTS
  Twenty patients completed the study. Patients with elevated ferritin levels on D0 had also fewer ventilator-free hours (p=0.046) and higher maximum inotropic score (p=0.009). Patients with cardiac dysfunction by echocardiogram on D1 had longer hospital stay (p=0.047), pediatric intensive care unit stay (p=0.020), duration of mechanical ventilation (p=0.011), maximum inotropic score (p=0.001), and fewer ventilator-free hours (p=0.020).
  
  
  CONCLUSIONS
  Cardiac dysfunction by echocardiography and serum ferritin value was significantly associated with unfavorable outcomes in pediatric patients with sepsis.
authors.affiliation: Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Hospital São Lucas, Unidade de Terapia Intensiva, Porto Alegre, RS, Brazil; Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Programa de Pós-Graduação em Pediatria e Saúde da Criança, Porto Alegre, RS, Brazil. Electronic address: cristiantonial@gmail.com.
authors.forename: Cristian T
authors.initials: CT
authors.lastname: Tonial
authors.affiliation: Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Hospital São Lucas, Unidade de Terapia Intensiva, Porto Alegre, RS, Brazil; Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Programa de Pós-Graduação em Pediatria e Saúde da Criança, Porto Alegre, RS, Brazil; Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Bolsista de Produtividade em Pesquisa, Brazil.
authors.forename: Pedro Celiny R
authors.initials: PCR
authors.lastname: Garcia
authors.affiliation: Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Hospital São Lucas, Serviço de Cardiologia Pediátrica, Porto Alegre, RS, Brazil.
authors.forename: Louise Cardoso
authors.initials: LC
authors.lastname: Schweitzer
authors.affiliation: Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Programa de Pós-Graduação em Pediatria e Saúde da Criança, Porto Alegre, RS, Brazil.
authors.forename: Caroline A D
authors.initials: CAD
authors.lastname: Costa
authors.affiliation: Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Hospital São Lucas, Unidade de Terapia Intensiva, Porto Alegre, RS, Brazil.
authors.forename: Francisco
authors.initials: F
authors.lastname: Bruno
authors.affiliation: Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Programa de Pós-Graduação em Pediatria e Saúde da Criança, Porto Alegre, RS, Brazil; Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Hospital São Lucas, Unidade de Terapia Intensiva Neonatal, Porto Alegre, RS, Brazil.
authors.forename: Humberto H
authors.initials: HH
authors.lastname: Fiori
authors.affiliation: Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Hospital São Lucas, Unidade de Terapia Intensiva, Porto Alegre, RS, Brazil.
authors.forename: Paulo R
authors.initials: PR
authors.lastname: Einloft
authors.affiliation: Cambridge University Hospitals NHS Trust, Pediatric Intensive Care Unit, Cambridge, United Kingdom.
authors.forename: Ricardo Branco
authors.initials: RB
authors.lastname: Garcia
authors.affiliation: Hospital de Clínicas de Porto Alegre (HCPA), Unidade de Terapia Intensiva Pediátrica, Porto Alegre, RS, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Saúde da Criança e Adolescente, Porto Alegre, RS, Brazil.
authors.forename: Jefferson Pedro
authors.initials: JP
authors.lastname: Piva
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D015150:Echocardiography, Doppler; D005260:Female; D005293:Ferritins / Q000097:blood* / Q000378:metabolism*; D006321:Heart / Q000503:physiopathology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay; D007958:Leukocyte Count; D008297:Male; D011446:Prospective Studies; D018805:Sepsis / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein; D005293:Ferritins
keywords: Choque séptico; Desfecho; Echocardiogram; Ecocardiograma; Outcome; Pediatric intensive care unit; Sepse; Sepsis; Septic shock; Unidade de Terapia Intensiva Pediátrica