Persistently low plasma thioredoxin is associated with meningococcal septic shock in children

Objective To compare plasma levels of thioredoxin (Trx), TNF-α and IL-1β in children during the acute phase of meningococcal septic shock (MSS) and in convalescence. Design and setting Retrospective, observational study in the paediatric intensive care unit of a postgraduate teaching hospital. Patients Thirty-five children requiring intensive care for meningococcal sepsis; paired convalescent samples from 30 survivors (median interval between samples 62 days); 25 healthy control children. Measurements and results Plasma Trx levels were significantly lower in the children with MSS, both during the acute illness (5.5 ng/ml, IQR 1.4–11.4) and in convalescence (2.5 ng/ml, IQR 0.4–6.9) than controls (18.8 ng/ml, IQR 7.9–25.0). Levels of IL-1β and TNF-α were higher in patients with acute MSS (30.3 pg/ml, IQR 3.6–63.6, and 145.9 pg/ml, IQR 31.8–278.1 respectively) than controls (3.7 pg/ml, IQR 0–36.9, and 23.8 pg/ml, IQR 0–124.3, respectively). Levels fell in convalescence (3.7 pg/ml, IQR 0–25.5, 3.7 pg/ml, IQR 0–304.8, respectively). Plasma Trx was higher in non-survivors, albeit a small group (n = 5), than in survivors (n = 30). Trx, IL-1β, and TNF-α levels were not correlated with predicted mortality as assessed by the paediatric risk of mortality (PRISM) score. Conclusions Children with MSS exhibit persistently low plasma levels of Trx during acute illness and in convalescence.