Objective: To determine whether plasma nitrite and nitrate concentrations are associated with the development of sepsis-induced multiple organ failure.
Design: Prospective study.
Setting: University children's hospital.
Patients: Fifty-three consecutive children meeting criteria for sepsis and not receiving exogenous sources of nitric oxide.
Interventions: 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.
Measurements and main results: 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.
Conclusion: Increased plasma nitrite and nitrate concentrations are associated with the development of multiple organ failure in pediatric sepsis.