abstract
- Introduction: Biomarkers that predict the severity of a disease on admission would be a valuable tool for pediatricians. Ferritin has been proposed as a predictive biomarker for various conditions; however, multiple thresholds have been described depending on the diagnosis. A threshold for severe pediatric disease regardless of the final diagnosis is lacking. Material and Methods: We performed a single-center retrospective observational study of patients admitted to the emergency department (ED) of a pediatric reference hospital in Mexico. Serum ferritin levels were requested to all admitted patients <16 years old and included in the study. Risk prediction models for various clinical outcomes were built using receiver operating characteristic (ROC) curves. Results: Admission ferritin levels were significantly higher in patients who required vasopressors (p < 0.001), blood transfusion (p < 0.001), and admission to the pediatric intensive care unit (PICU; p < 0.001). Patients with admission ferritin >500 ng/mL had a longer hospital stay (p = 0.037). Admission ferritin was a predictor of all-cause mortality (area under the curve [AUC] = 0.67, 95% confidence interval [CI]: 0.54¿0.80, p = 0.009; sensitivity 55%, specificity 76.3%). A cut-off point of 385 ng/mL was associated with mortality (OR 3.21, 95% CI: 1.29¿7.97). Conclusion: We provide evidence that ferritin may be used as a predictive biomarker in the pediatric ED. In our study, ferritin levels on admission predicted all-cause mortality. Multicenter studies are required to validate our findings in a larger sample.