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Effect of Sepsis on Iron Parameters in a Population with High Prevalence of Malnutrition and Iron Deficiency: A Cross-Sectional Case–Control Pilot Study

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Abstract

There is lack of data on iron metabolism in critically ill sepsis children from population with high prevalence of iron deficiency (ID). The study was designed to study impact of sepsis on iron parameters in children with ID. Sepsis patients (age 6–59 months) and their apparently healthy sibling/cousin as controls were enrolled in this case–control pilot study. Serum iron, TIBC, transferrin saturation, ferritin and sTfR were measured in the two groups. sTfR-Ferritin index was calculated. Patients (n = 134) were significantly underweight compared to controls (n = 54) (WAZ score < − 2; 58% vs. 28%; p < 0.001). Serum iron and sTfR (mg/L) were lower [71.5 (51.0, 115.0) vs. 87.0 (64.5, 130.5), p = 0.068; 3.1 (2.1, 4.5) vs. 3.5 (2.8, 4.8), p = 0.026 respectively] while serum ferritin was higher [229 (94, 484.5) vs. 22 (9.2, 51); p < 0.001] in patients compared to controls. sTfR-Ferritin index was lower in patients [1.3 (0.8, 2.3) vs. 2.5 (1.8, 4.5); p < 0.001]. ROC AUC (patients vs. controls) were 0.89 (95% CI 0.83–0.95) and 0.76 (95% CI 0.68–0.85) for ferritin and sTfR-ferritin index respectively. Survivors and non-survivors were similar in terms of iron parameters. Sepsis-induced alterations in iron parameters among ID children are complex. Qualitatively it is similar (with quantitative differences) to non-ID adult population. Lack of correlation of iron parameters with mortality may be due to ID-associated immune dysfunction.

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Acknowledgements

This study was performed at Division of Pediatric Critical Care, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

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Authors and Affiliations

  1. Division of Pediatric Critical Care, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India

    Arun K. Baranwal

  2. Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

    Reena Das

  3. Division of Pediatric Critical Care, Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India

    Ramachandran Rameshkumar

  4. Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

    Praveen Kumar-M

  5. Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India

    Prateek Bhatia MD, DNB, PGDHM, MIPHA & Ashwini Nair MSc

Authors
  1. Arun K. Baranwal
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  2. Reena Das
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  4. Praveen Kumar-M
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  5. Prateek Bhatia MD, DNB, PGDHM, MIPHA
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  6. Ashwini Nair MSc
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Contributions

Arun Kumar Baranwal: Conceptualization, Study design, Fund Acquisition, Data curation, Literature search, Original and Final draft preparation, Supervision of Statistical analysis, Guarantor. Reena Das: Conceptualization, Methodology, Laboratory analysis, Supervision, Critical review and Editing. Ramachandran Rameshkumar: Data collection, Data curation, Review and Editing. Praveen Kumar-M: Statistical analysis, Data curation, Software. Prateek Bhatia: Literature search, Review and Editing. Ashwini Nair: Literature search, Data curation, Statistical analysis.

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Correspondence to Arun K. Baranwal.

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Supplementary Figure 1

Multi-correlation plot between different iron parameters for patients and control. Spearman correlation coefficient [rho (ρ)] and associated p values are mentioned for each comparison. Density plots are depicted in the diagonal line.(JPEG 2888 kb)

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Baranwal, A.K., Das, R., Rameshkumar, R. et al. Effect of Sepsis on Iron Parameters in a Population with High Prevalence of Malnutrition and Iron Deficiency: A Cross-Sectional Case–Control Pilot Study. Indian J Hematol Blood Transfus 37, 609–615 (2021). https://doi.org/10.1007/s12288-020-01393-7

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