Role of Serum Ferritin and PRISM-III in Predicting Mortality in Children with Acute Encephalitis Syndrome in Northern India

Objectives: The aim of this study was to evaluate the role of Serum Ferritin (SF) and PRISM-III (Paediatric Risk of Mortality) in predicting mortality in critically ill children aged six months to 15 years diagnosed with Acute Encephalitis Syndrome (AES) admitted to the Paediatric Intensive Care Unit (PICU). Methods: This prospective observational study was conducted in the PICU of a tertiary teaching hospital in Northern India between July 2018 and June 2019. The primary outcome was to determine the association of admission SF levels with mortality. Secondary outcomes included estimating the prevalence of hyperferritinemia and comparing SF with PRISM-III scores in predicting mortality. Results: Etiology could be established in 85.5% (n=219) of the 256 children enrolled. Scrub Typhus accounted for nearly two-thirds of the cases (60.5%), while Dengue and Japanese Encephalitis were the next common diagnoses. The median [IQR] SF at admission was significantly higher among the non-survivors than survivors, 514 [260, 1857] and 318 [189, 699] μg/L, respectively (p=0.029). SF and PRISM-III independently predicted mortality in AES. However, both had poor discriminatory power with Area Under Receiver Operating Characteristic curve (AUROC) (95% CI) of 0.61 (0.51, 0.72) and 0.67 (0.56, 0.77), respectively. Conclusions: Elevated SF and higher PRISM-III scores independently predicted mortality in children admitted to PICU with AES.