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Inflammation and psychopathology in children following PICU admission: an exploratory study
  1. Giorgia Caspani1,
  2. Georgina Corbet Burcher2,
  3. M Elena Garralda2,
  4. Mehrengise Cooper3,
  5. Christine M Pierce4,
  6. Lorraine C Als2,
  7. Simon Nadel3
  1. 1 Department of Surgery and Cancer, Imperial College London, London, UK
  2. 2 Centre for Psychiatry, Imperial College London, London, UK
  3. 3 Department of Paediatric Intensive Care, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, UK
  4. 4 Department of Paediatric Intensive Care, Great Ormond Street Hospital, London, UK
  1. Correspondence to Giorgia Caspani, Department of Surgery & Cancer, Imperial College London, London, SW7 2AZ , UK; giorgia.caspani{at}gmail.com

Abstract

Background Survivors of critical illness in childhood commonly display subsequent psychiatric symptoms including emotional and behavioural difficulties, and manifestations of post-traumatic stress disorder (PTSD). Anomalies in inflammatory profiles are an established finding in these childhood psychiatric conditions.

Objective This exploratory study aimed to investigate whether abnormal peripheral blood inflammatory markers measured during paediatric intensive care unit (PICU) admission were associated with psychiatric symptoms after discharge.

Methods We performed a prospective observational cohort study on 71 children with septic illness, meningoencephalitis and other critical disorders admitted to two PICUs between 2007 and 2010. 3–6 months following discharge, subjects were assessed for global psychiatric risk (ie, presence of emotional and behavioural difficulties on the parental Strengths and Difficulties Questionnaire (SDQ)), and for PTSD risk using the child-rated Impact of Events Scale (IES-8). Inflammatory and related biological markers were transcribed from PICU admission notes (white cell count, lymphocytes, neutrophils, C reactive protein (CRP), platelets, fibrinogen and lactate).

Findings Global psychiatric risk at follow-up was associated with abnormal lymphocyte count during admission (χ2=6.757, p=0.014, n=48). In children with sepsis, partial correlation analyses controlling for age and gender highlighted associations between (i) SDQ scores and low lymphocyte count (r=−0.712; p=0.009, n=14), and (ii) IES-8 score and high CRP levels (r=0.823; p=0.006, n=11). These associations remained after correction for multiple comparisons.

Conclusion These results support the hypothesis that acute inflammation may play a role in determining the development of psychopathology following PICU admission.

Clinical implications If the findings are replicated, they may help to better highlight which children are at risk of post-PICU psychopathology and appropriately target follow-up.

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

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Footnotes

  • GC and GCB contributed equally.

  • Funding GC was funded by the MRC (grant number MR/N014103/1). GCB was funded by the National Institute for Health Research. This research was undertaken at Imperial College Academic Health Science Centre and Great Ormond Street Hospital for Children NHS Trust, both of which are supported by the Department of Health National Institute for Health Research Biomedical Research Centres funding scheme. The original research was supported by a grant from the Meningitis Research Foundation.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Research Ethics Committee (Hammersmith Hospital)

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional unpublished data are available.

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