Prognostic markers among Egyptian children with sepsis in the Intensive Care Units, Cairo University Hospitals.

BACKGROUND: Early identification of septic patients at risk of mortality is important in their prognosis.

OBJECTIVE: Identification of septic patients at risk of mortality in Pediatric Intensive Care Units (PICUs) at Cairo University Hospitals, through measuring the levels of certain immunological parameters.

METHODS: A hospital-based prospective cohort study was conducted in two PICUs at Cairo University Hospitals; all patients with diagnosis of severe sepsis or septic shock on admission were included. A total of 57 patients were prospectively followed at the selected PICUs and their demographic and clinical data were recorded. Microbiological and immunological workup (at days 1 and 7) was conducted for all patients to detect the causative organism of sepsis and to measure the levels of immunoglobulins (IgG, IgM and IgA), complement factors (C3 and C4), mature lymphocyte subpopulations (CD3+) and natural killer (NK) cells (CD3-CD16+CD56+), respectively.

RESULTS: Mortality rate was 24.6%; the most frequent causes of death were multi-organ dysfunction and refractory shock. PELOD and PRISM III scores were significantly higher among non-survivors. At day 1, non-survivors had significantly higher levels of IgG, C4 and NK cells than survivors. However, from day 1 to day 7, survivors had a progressive increase in most of the immunological parameters (IgG, IgM, C4and CD3+ T lymphocytes). Survival curve analysis revealed the significant predictive ability of NK cells to detect early mortality.

CONCLUSION: Monitoring the levels of cellular and humoral immunological parameters together with assessing PELOD and PRISM III scores can significantly affect prognosis and survival of septic children.