Very high serum ferritin levels are associated with increased mortality and critical care in pediatric patients

Objective: To determine whether an elevated serum ferritin level is independently associated with mortality and receipt of critical care in pediatric patients. Design: Retrospective cohort study, open population. Setting: Seattle Children's Hospital, Seattle, WA, from September 2, 2003, to February 15, 2008. Patients: All patients tested for serum ferritin level from September 2, 2003, to August 16, 2007, with a level >= 1000 ng/mL. Interventions: None. Main Analysis: Cox regression. Measurements and Main Results: The predictor of interest was the patient-specific peak serum ferritin level, dichotomized a priori at 3000 ng/mL. The outcomes were mortality and intensive care unit admission. A total of 171 patients met the inclusion criteria. The observation time without death or intensive care unit admission ranged from 184 to 1621 days. The hazard ratio of death with peak ferritin of >3000 ng/mL was 4.32 (95% confidence interval 2.21-8.47, p < .001) compared to peak ferritin of 1000-3000 ng/mL. The hazard ratio of intensive care unit admission with peak ferritin of >3000 ng/mL was 2.49 (95% confidence interval 1.53-4.05, p < .001) compared to peak ferritin of 1000-3000 ng/mL. Both estimates were adjusted for bone marrow transplant, solid organ transplant, hemoglobinopathy, and existing rheumatologic disease. Conclusion: In this pediatric population, with serum ferritin levels of >3000 ng/mL, there was increased risk for both receipt of critical care and subsequent death. (Pediatr Crit Care Med 2011; 12:e233-e236)