Arnab NANDY
(NB Medical College, Department of Pediatrics, India)
Tanushree MONDAL
(Medical College, Department of Community Medicine, India)
Mihir SARKAR
(Medical College, Department of Pediatrics, India)
Shankha Subhra NAG
(NB Medical College, Department of Pediatrics, India)
Soumita CHEL
(University of Glasgow, Department of Data Science, Scotland)
Divyoshanu M. IVAN
(Delhi Technological University, Department of Biotechnology, India)
Avijit HAZRA
(IPGMER and SSKM Hospital, Department of Pharmacology, India)
Rakesh MONDAL
(Medical College, Department of Pediatric Medicine, Division of Rheumatology, India)
Yıl: 2021Cilt: 8Sayı: 2ISSN: 2147-9720 / 2148-4279Sayfa Aralığı: 89 - 92İngilizce

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Multiorgan dysfunction syndrome in sepsis: Is macrophage activation syndrome secondary to infection?
Objective: To assess macrophage activation syndrome (MAS) in septic shock leading to multiorgandysfunction syndrome (MODS).Methods: A prospective observational study was conducted at a tertiary care hospital to evaluate theMAS criteria in different stages of sepsis. Children aged 6 months to 12 years in different stages of septic shock were recruited. The Paediatric Rheumatology International Trials Organisation CollaborativeInitiative (PRINTO) criteria of MAS were applied initially at the stage of septic shock and subsequentlyat the stage of MODS (MODS cohort) or following recovery from septic shock without going throughMODS (non-MODS cohort).Results: A total of 127 subjects were studied, with 53 comprising the MODS cohort and the rest 74 thenon-MODS cohort. At the initial assessment, a comparable proportion of subjects in the MODS andnon-MODS groups satisfied the MAS criteria (20.75% and 25.68%, respectively; p=0.529). However,by the time of progression to MODS, 81.13% of the subjects satisfied the MAS criteria in the MODSgroup, whereas only 16.18% subjects in the non-MODS group continued to satisfy the MAS criteria(p<0.001). Thus, there was a definite increase in the proportion of subjects showing MAS by the timethey progressed to multiorgan dysfunction (p<0.001). In contrast, the proportion declined significantly (25.68% to 16.18%; p=0.008) in the subjects who had recovered.Conclusion: The findings bear out the hypothesis that MODS in sepsis is a reflection of MAS secondaryto sepsis. However, studies in larger cohorts are needed to validate these findings and explore thetherapeutic implications.
DergiAraştırma MakalesiErişime Açık
  • 1. Ismail J, Jayashree M. Advances in the management of pediatric septic shock: Old questions, new answers. Indian Pediatr 2018; 55: 319-25.
  • 2. Mizock BA. The multiple organ dysfunction syndrome. Dis Mon 2009; 55: 476-526.
  • 3. Ravelli A, Grom AA, Behrens EM, Cron RQ. Macrophage activation syndrome as part of systemic juvenile idiopathic arthritis: Diagnosis, genetics, pathophysiology and treatment. Genes Immun 2012; 13: 289-98.
  • 4. Boomer JS, To K, Chang KC, Takasu O, Osborne DF, Walton AH, et al. Immunosuppression in patients who die of sepsis and multiple organ failure. J Am Med Assoc 2011; 306: 2594-605.
  • 5. Ravelli A, Minoia F, Davì S, Horne A, Bovis F, Pistorio A, et al. 2016 Classification criteria for macrophage activation syndrome complicating systemic juvenile idiopathic arthritis: A European League against Rheumatism/American College of Rheumatology/Paediatric Rheumatology International Trials Organisation Collaborative Initiative. Arthritis Rheumatol 2016; 68: 566-76.
  • 6. Spapen HD, Jacobs R, Honoré PM. Sepsis-induced multi-organ dysfunction syndrome - a mechanistic approach. J Emerg Crit Care Med 2017; 1: 2-9.
  • 7. Kyriazopoulou E, Leventogiannis K, Norrby-Teglund A, Dimopoulos G, Pantazi A, Orfanos SE, et al. Macrophage activation-like syndrome: An immunological entity associated with rapid progression to death in sepsis. BMC Med 2017; 15: 2-10.
  • 8. Carcillo JA, Simon DW, Podd BS. How we manage hyperferritinemic sepsis related MODS/ Macrophage Activation Syndrome/Secondary HLH. Pediatr Crit Care Med 2015; 16: 598-600.
  • 9. Rosário C, Zandman-Goddard G, Meyron-Holtz EG, D’Cruz DP, Shoenfeld Y. The hyperferritinemic syndrome: Macrophage activation syndrome, Still’s disease, septic shock and catastrophic antiphospholipid syndrome. BMC Med 2013; 11: 2-11.
  • 10. Carcillo JA, Podd B, Aneja R, Weiss SL, Hall MW, Cornell TT, et al. Pathophysiology of pediatric multiple organ dysfunction syndrome. Pediatr Crit Care Med 2017; 18: S32-45.
  • 11. Balasubramanian S, Rao NM, Goenka A, Roderick M, Ramanan AV. Coronavirus Disease (COVID-19) in children-what we know so far and what we do not?. Indian Pediatr 2020; 57: 435-42.
  • 12. Ceribelli A, Motta F, De Santis M, Ansari AA, Ridgway WM, Gershwin ME, et al. Recommendations for coronavirus infection in rheumatic diseases treated with biologic therapy. J Autoimmun 2020; 109: 102442.

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