Role of Serum Ferritin and PRISM-III in Predicting Mortality in Children with Acute Encephalitis Syndrome in Northern India

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

Note

This study was conducted at Baba Raghav Das Medical College, Gorakhpur, Uttar Pradesh, India.

Ethical Approval

Ethical approval was obtained from the Institutional Ethical Committee (IEC) of BRD Medical College, Gorakhpur, Uttar Pradesh.

Name of the institution where the work was performed:

Lay summary: Serum ferritin and PRISM-III independently predicted mortality in children admitted with acute encephalitis syndrome in the pediatric intensive care unit.

Publication History

Received: 23 March 2022

Accepted: 05 May 2022

Article published online:
03 July 2022

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