Plasma nitrite and nitrate concentrations and multiple organ failure in pediatric sepsis

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Abstract
To determine whether plasma nitrite and nitrate concentrations are associated with the development of sepsis-induced multiple organ failure. Prospective study. University children's hospital. Fifty-three consecutive children meeting criteria for sepsis and not receiving exogenous sources of nitric oxide. Plasma nitrite and nitrate concentrations were measured, and the number of organs failing was scored using an organ failure index on the first 3 days of sepsis. Children with three or more organs failing on day 3 of sepsis had higher plasma nitrite and nitrate concentrations than children who had resolution of failure of three or more organs by day 3 of sepsis (days 2 and 3) and children who never had three organs failing in the first 3 days of sepsis (days 1, 2, and 3). Children who developed sequential pulmonary/hepatic/renal organ failure had significantly higher plasma nitrite and nitrate concentrations (days 1, 2, and 3). Nonsurvivors had significantly higher plasma nitrite and nitrate concentrations (days 2 and 3) than survivors. Plasma nitrite and nitrate concentrations on day 1 predicted the development of persistent failure of three of more organs and sequential multiple organ failure but not mortality. Increased plasma nitrite and nitrate concentrations are associated with the development of multiple organ failure in pediatric sepsis. (Crit Care Med 1998; 26:157-162)