Pediatric anesthesia & critical care
Epstein-Barr Virus Seropositivity, Immune Dysregulation, and Mortality in Pediatric Sepsis
Authors' conclusion
In this cohort study of pediatric sepsis, EBV seropositivity was associated with immune dysregulation and mortality.
Study context
- Population
- Children with sepsis in the PHENOMS study who had not previously received intravenous immune globulin
- Participants
- 320 children
- Exposure
- Epstein-Barr virus (EBV) seropositive vs seronegative
- Outcome
- Causal associations between EBV seropositivity, immune dysregulation biomarkers, macrophage activation syndrome (MAS), and death
Methodological details9-center, causal inference analysis (directed acyclic graphs), mediation analysis, structural equation modeling, Blood samples and clinical data collected January 1, 2015, to December 31, 2018
- 9-center
- Causal inference analysis (directed acyclic graphs)
- Mediation analysis
- Structural equation modeling
- Blood samples and clinical data collected January 1, 2015, to December 31, 2018
Main finding
As reported in the abstract
EBV seropositivity associated with mortality, estimate [SE]
1.86
0.55P < .001
With ferritin in the model, EBV seropositivity effect on death, estimate [SE]
1.52
0.57P = .007
Ferritin effect on death (model with EBV seropositivity), estimate [SE]
0.50
0.15P = .001
EBV seropositivity and death after adjustment for macrophage activation syndrome (MAS), estimate [SE]
1.78
0.56P = .001
Observational data: associations, not effects.
Further findings
EBV seropositivity and immune dysregulation biomarkers
- 172 (53.8%) had causal associations with death directly and via hyperferritinemia and MAS, and direct causal associations with increased CRP, ferritin and IL-18 binding protein, which in turn were causally associated with decreased ADAMTS13 activity and decreased ex vivo TNF response to endotoxin
Original publication
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