Correlation between tumor necrosis factor-alpha and septic shock in children

Background The crucial role cytokines play in the pathophysiology of sepsis is widely accepted. Infection stimulates the production of cytokines in various cell types. Tumor necrosis factor-alpha (TNF-a) is one of the most extensively investigated cytokines in experimental and clinical sepsis. Tumor necrosis factor-alpha has been shown to mediate lethality in experimental sepsis. Objective To evaluate for a possible correlation between TNF-a level and septic shock in children. Methods This cross-sectional study was conducted in Manado from June to September 2011. A total of 40 patients with a recent diagnosis of sepsis or septic shock were included. Plasma specimens were collected from subjects for measurement of TNF-a concentration. Logistic regression analysis was used to assess the correlation between TNF-a level and sepsis, as well as the probability of shock in children with sepsis, with P<0.05 as statistically significant. Results There was a strong positive correlation between TNF-a level and the probability of shock in children with sepsis (regression coefficient = 0. 78, P = 0.002). Conclusions There is a strong positive correlation between TNF-a level with the probability of shock in children with sepsis. Higher plasma level ofTNF-a is associated with higher probability of septic shock

Serum nitric oxide and pediatric sepsis outcomes

Background Sepsis is the complex pathophysiologic responses of the host against systemic infection. Sepsis can cause severe conditions such as septic shock and multiple organ failure. Although we have a better understanding of the molecular basis of sepsis as well as aggressive therapy, the mortality rate remains high, between 20-80%. Nitric oxide (NO) is one of the mediators associated with cardiovascular failure, apoptosis and organ dysfunction in sepsis. Objective To evaluate for a possible correlation between NO levels and outcomes in pediatric sepsis. Methods A prospective cohort study was conducted at the pediatric intensive care unit (PICU) of Prof. Dr. R.D. Kandou General Hospital in Manado, from June to November 2012. Forty children aged one month to five year old, fulfilled the International Pediatrics Sepsis Consensus Conference 2 005 criteria were recruited. Nitrite oxide metabolites (nitrite and nitrate) levels were measured using a calorimetric assay kit (Cayman®, Catalog No.780001) from venous blood specimens collected at admission. All patients received antibiotics empirically within an hour of the diagnosis. Outcomes of patients recorded were survivor or died, and length of stay in PICU. Results Mann-Whitney U test revealed a significant difference between median serum NO levels ins urvivors and those who died (18.60 vs. 36.50 fLM/L, respectively; P= 0.016). Conclusion Serum NO concentration is higher in those who died than in survivors of pediatric sepsis. Specific NO inhibition may be beneficial in decreasing morbidity and mortality in this condition

Validation of the Signs of Inflammation in Children that can Kill (SICK) score for assessment of illness severity

Background The Signs of Inflammation in Children that can Kill (SICK) score has been developed in the search for a practical triage tool in settings with limited resources for immediate, noninvasive assessment of illness severity. Its seven parameters are heart rate, respiratory rate, systolic blood pressure, temperature, blood oxygen saturation (Sp02), capillary refill time (CRT), and level of consciousness. The SICK score also takes into account the age of the child. Objective To assess the validity of SICK scores for differentiating between high and low probabilities of death in children. Methods We performed a prospective evaluation of all children aged between one month to twelve years admitted to the Pediatric Emergency Care Unit at Prof. Dr. R.D. Kandou Hospital, Manado between October 2011 to January 2012. We calculated SICK scores at the time of presentation and assessed their correlation with subsequent in-hospital mortality using logis tic regression analysis. Results During the study period, we observed 230 patients, of whom 199 survived and 31 died. There were 134 males, of whom 117 survived and 17 died. The remaining 96 subjects were female, of whom 82 survived and 14 died. Logistic regression analysis revealed a significant relationship between SICK score and mortality (P< 0.001). With a probability of 0.5, we attained a cut off score of 4.74 points, with 96.8% sensitivity and 99.5% specificity for the prediction of mortality. Conclusion T he high SICK score is associated with higher probability of death. A cut off score of 4. 74 has high sensitivity and specificity for predicting the probability of death. The SICK score may be useful as a triage tool at the patient's initial presentation, particularly in settings with limited resources

Prognostic value of nitric oxide in pediatric septic shock

Background Nitric oxide (NO) play a key role in the pathogenesis of septic shock. Nitrit oxide metabolite is reported as a good predictor for shock although its role as mortality predictor in sepsis still controversial. Objective To assess the serum nitric oxide (NO) levels and outcomes in pediatric patients with septic shock. Methods We conducted a prospective cohort study from January 2013 to April 2014 in Pediatric Intensive Care Unit (PICU) Prof. Dr. R. D. Kandou Hospital, Manado. Subjects were patients aged 1 month-12 years diagnosed with septic shock. We measured initial serum NO and observed its outcomes in all subjects. Results A total of 37 patients with septic shock met the study criteria. Nineteen children were male (51.4%). Seventeen subjects died and 20 subjects survived. The mean age of subjects with septic shock was 37.3 (SD 14.2) months. The mean serum NO level was significantly higher in the group who died [33.2 μM; 95% CI 23.6 to 42.7] than in the group who survived [13.8 μM; 95%CI 11.6 to 15.9] (P<0.01). The serum NO cut-off point for predicting mortality was 16.15 µM. For NO levels of more than 16.15 µM, the positive predictive value was 72.2% and negative predictive value was 78.9% (OR 9.750; 95%CI 2.154 to 44.138). Conclusion In pediatric patients with septic shock, serum NO levels are significantly higher in those who died than in those who survived. Serum nitric oxide level can be used to predict outcomes of patients with septic shock

Hubungan Kadar Serum Metabolit Nitrit Oksida dan Gangguan Fungsi Ginjal pada Sepsis

Latar belakang. Sepsis adalah respons sistemik terhadap infeksi dengan salah satu komplikasinya berupa gagal organ ginjal. Peran nitrit oksida (NO) sebagai mediator yang terlibat dalam mekanisme gagal organ ginjal kasus sepsis masih bersifat kontroversi. Tujuan. Mengevaluasi hubungan antara kadar serum NO dan gangguan fungsi ginjal pada sepsis anak. Metode. Desain penelitian potong lintang secara konsekutif dilaksanakan sejak bulan Juni sampai November 2012 dengan sampel anak usia satu bulan sampai lima tahun yang didiagnosis sepsis. Pemeriksaan kadar serum kreatinin mencerminkan fungsi ginjal dan kadar serum metabolit NO (nitrat dan nitrit) mencerminkan kadar NO endogen. Uji korelasi menggunakan uji korelasi Spearman, dinyatakan bermakna apabila p<0,05. Data diolah menggunakan piranti lunak SPSS 19.00 Hasil. Diperoleh 40 subjek dengan median usia 8,5 bulan (2 sampai 70 bulan) dan 22 di antaranya anak laki-laki. Kadar metabolit NO ditemukan berhubungan dengan kadar serum kreatinin (rs=0,33; p=0,041). Kesimpulan. Terdapat hubungan antara peningkatan kadar serum NO dan terjadinya gangguan fungsi ginjal pada anak dengan sepsis

Lactate clearance and mortality in pediatric sepsis

Background Sepsis is a life-threatening condition often encountered in the pediatric intensive care unit. In the last five decades, despite the use of aggressive antibiotics and advances in intensive care medicine, the mortality rate of sepsis remains high. In 2005, the World Health Organization (WHO) estimated that 11 million children die annually due to sepsis, of these, 30,000 children under five years of age die daily. Serum lactate concentration is useful to evaluate the progression of sepsis in children. Lactate clearance can be used to evaluate the outcomes in sepsis management in children. Objective To evaluate the relationship between lactate clearance and patient mortality. We also attempted to assess the usefulness of lactate clearance as an early prognostic marker in pediatric sepsis. Methods This prospective cohort study was conducted at the Pediatrics Department of Prof Kandou General Hospital from November 2013 to April 2014. Consecutive sampling was undertaken on 45 children aged 1 month to 15 years who were diagnosed with sepsis according to the inclusion criteria. First lactate serum was measured immediately following patient admission to the PICU. The next serum lactate measurement was six hours after initial treatment in the PICU. Results The mean lactate clearance was higher in the survivors’ than in the non-survivors’ group (58.48%vs. 18.20%, respectively). Logistic regression analysis revealed a lactate clearance cutoff point of 34.7%, with sensitivity 87.50%, specificity 96.55%, positive predictive value 93.33%, and negative predictive value 93.33%. The formula used was y=1/{1+exp-(4.135-0.119 lactate clearance)}. Chi-square analysis of lactate clearance and mortality revealed an odds ratio (OR) of 196.0 (95%CI 16.34 to 2,351.53; P<0.001). Conclusion Higher lactate clearances significantly associate with lower mortality in children with sepsis