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Abstract

Objective: Sepsis in children is accompanied by marked inflammatory and metabolic perturbations. Conventional markers such as C-reactive protein (CRP) and procalcitonin (PCT) reflect inflammation but do not capture broader endocrine–metabolic responses. We therefore examined serum insulin-like growth factor-1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3) in preschool children with retrospectively adjudicated sepsis and explored their in-sample discriminatory ability within this dataset. This study was exploratory and was not designed to validate clinically actionable biomarkers. Methods: We conducted a retrospective case–control study of 73 children aged 4–6 years with retrospectively adjudicated sepsis and 80 age- and sex-matched healthy controls. For the sepsis cohort, residual serum from clinically indicated blood sampling obtained within 24 hours of admission was retrieved and assayed for IGF-1 and IGFBP-3; sampling time and fasting status were not standardized. Control samples were fasting morning specimens collected during routine health examinations. Group differences and correlations with CRP and PCT were analyzed, and receiver operating characteristic (ROC) curves were used to explore in-sample discrimination. Results: Children with sepsis had significantly lower IGF-1 (82.6 ± 15.4 vs. 138.2 ± 20.1 ng/mL) and IGFBP-3 (2.11 ± 0.47 vs. 3.05 ± 0.53 μg/mL) than controls (both P < 0.001). Both markers were inversely associated with CRP (IGF-1: r = −0.48, P < 0.001; IGFBP-3: r = −0.41, P = 0.0015), whereas correlations with PCT were not significant. In-sample ROC analyses yielded area under the curve (AUC) values of 0.737 for IGF-1, 0.849 for IGFBP-3, and 0.861 for the combined model. Conclusion: Among preschool children aged 4–6 years with retrospectively adjudicated sepsis, serum IGF-1 and IGFBP-3 were lower than in healthy controls and were inversely associated with CRP. In this retrospective case–control dataset, these markers showed exploratory in-sample discrimination between cases and controls. Prospective pediatric sepsis studies using standardized sampling, contemporary pediatric sepsis criteria, and external validation are required before any diagnostic or prognostic use.

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