Abstract
The aim of this study was to evaluate the role of serum ferritin (SF) and PRISM-III
(Pediatric Risk of Mortality) score in predicting mortality in critically ill children
aged 6 months to 15 years diagnosed with acute encephalitis syndrome (AES) admitted
to the pediatric intensive care unit (PICU). This prospective observational study
was conducted in the PICU of a tertiary teaching hospital in Northern India between
July 2018 and June 2019. The primary outcome was to determine the association of admission
SF levels with mortality. Secondary outcomes included estimating the prevalence of
hyperferritinemia and comparing SF with PRISM-III scores in predicting mortality.
Etiology could be established in 85.5% (n = 219) of the 256 children enrolled. Scrub typhus accounted for nearly two-thirds
of the cases (60.5%), while dengue and Japanese encephalitis were the next common
diagnoses. The median [interquartile range] SF at admission was significantly higher
among the nonsurvivors than survivors: 514 [260–1,857] and 318 [189–699] µg/L, respectively
(p = 0.029). SF and PRISM-III independently predicted mortality in AES. However, both
had poor discriminatory power with area under receiver operating curve (95% confidence
interval) of 0.61 (0.51–0.72) and 0.67 (0.56–0.77), respectively. Elevated SF and
higher PRISM-III scores independently predicted mortality in children admitted to
PICU with AES.
Keywords
hyperferritinemia - pediatric intensive care unit - pediatric - mortality - scrub
typhus
