Elevated total bile acid levels as an independent predictor of mortality in pediatric sepsis

Abstract

Background

The close relationship between bile acid (BA) metabolism and sepsis has been investigated in recent years, as knowledge of the role of the gut microbiome and metabolomics in sepsis has grown and become more comprehensive.

Methods

Patients with sepsis who were admitted to the PICU of the Children’s Hospital, Zhejiang University School of Medicine from January 2016 to December 2021 were enrolled in this study. Preoperative non-infectious pediatric patients undergoing elective surgeries in our hospital’s department of surgery were recruited as controls during the same period. Clinical data were collected and analyzed.

Results

702 children were enrolled, comprising 538 sepsis survivors, 164 sepsis fatalities, and 269 non-infected controls. Statistical analysis revealed that total BA (TBA) increased in both the early and severe stages of pediatric sepsis. In the severe stage, TBA (OR = 2.898, 95% CI 1.946–4.315, p < 0.05) was identified as a risk factor for sepsis. A clinical model identified TBA (the cut-off value is >17.95 µmol/L) as an independent predictor of sepsis mortality with an AUC of 0.842 (95% CI 0.800–0.883), sensitivity of 54.9%, specificity of 96.6%, and HR = 7.658 (95% CI 5.575–10.520).

Conclusions

The study showed that elevated TBA was associated with a heightened risk of mortality in pediatric sepsis.

Impact

• Many clinical indicators show differences between children with sepsis and the control group, among which the difference in serum total bile acid levels is the most significant.

• During the hospitalization of the patients, the overall bile acid levels in the sepsis death group were higher and exhibited greater fluctuations compared to the survival group, with significant differences.

• Serum total bile acid levels can serve as effective biomarker for predicting the prognosis of children with sepsis.