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Abstract
Background: Anemia in the critically ill patients is frequent and multifactorial, with the two main contributing factors being inflammation and iron deficiency. Objective: to report the serum hepcidin values among anemic critically- ill children, to investigate the relationship, between serum hepcidin and various clinical and laboratory characteristics and to assess the predictability of iron deficiency in critically ill children by serum hepcidin. Results: The main admitting diagnoses were pneumonia in 32.5%, and bronchopneumonia in 19%. PIM score ranged from 2.4 to 100. Forty-nine (61.25%) had blood transfusion during admission. Low serum iron (mean of 32.9 mg/dl) was seen in 81%, 64%) had elevated serum ferritin, and 4% had low ferritin. Mean serum hepcidin was 2.45 ng/mL with 63.75% of the patients had elevated serum hepcidin above the referral range. Mortality rate was 49%. Children with negative CRP; group 1 (n=29) and those with positive CRP; group 2 (n=51) were comparable regarding their age. group 1 had significantly lower mean Hepcidin (p=0.001) and TIBC (p=0.02), and higher serum iron (p=0.01), when compared to group 2. Hepcidin was found to correlate inversely with hemoglobin (r=-0.2; p=0.05), hematocrit (r=-0.2; p=0.04) and serum iron (r=-0.2; p=0.04) and proportionally with PIM score (r=-0.2; p=0.03), C-reactive protein (r= 0.4, p=0.04) and serum ferritin (r=0.2, p=0.03). ROC curve showed that area under the curve (AUC) of hepcidin was 0.4; (p=0.04). Conclusions& recommendations: Serum hepcidin values were higher than normal in the vast majority of anemic critically-ill children due to acute inflammation. Low serum hepcidin is an indicator of iron deficiency anemia and serum hepcidin levels {u2265}3.11 ng/ml can predict iron deficiency anemia in critically ill children who developed anemia during PICU admission even in the presence of inflammation.