الفهرس 
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Abstract
Sepsis is a life threating condition which represents a major cause of mortality and morbidity among critically ill patients despite the use of modern management strategies. So early diagnosis of sepsis is important to reduce these complications. Human leptin plays a role in activation of immune system and act as a mediator of inflammation.it is also involved in a systemic response to sepsis. So, leptin deficiency is associated with increasing frequency of infections. The aim of this study was to assess serum leptin in diagnosing sepsis in critically ill pediatric patients. Our study conducted on 50 children classified in to: • Case group: included 40 critically ill pediatric patients (21 male, 19 female) aged between 1 and 13 years (mean 4.2 +3.7) Initially they were sepsis free and fulfilling 2 of 4 criteria of SIRS admitted to the Pediatric Intensive Care Unit, children hospital, Tanta university .in enrollment of the study, our patients were classified in two groups according to presence or absence of infection in to SIRS group (n=25) and sepsis group (n=15). • Control group: included (10) apparently healthy children matched for the same age and sex with no clinical signs of sepsis recruited from relatives of the patients in PICU. For all studied patients; serum leptin, CRP and others indicators of sepsis as temperature, HR, WBCS and platelets were measured at admission and 72h later, while were measured one time only for control group. Patients with sepsis, who had received corticosteroids before admission, who had immunosuppressive illness, who had chronic organ SUMMARY 102 failure, who had received massive blood transfusion, or whose anticipated duration of stay was less than 24 hours were excluded from the study. The summary of our results: • There was no statistical significant difference between cases and controls as regard age and sex. • Status epilepticus was the main cause of PICU admission (27.5%), followed by DKA (20%) and the least cause was organophosphorus poisoning (7.5%). • There was statistically-significant difference in relation to temperature between septic patients and both SIRS patient and controls (38.9+ 0.2 vs. 37.3 + 0.7, 36.7 ±8.25 respectively, P>0.05). • There was statistically-significant difference in relation to CRP between septic patients and both SIRS patient and controls (70.4 + 4.6 vs. 15 + 2.1, 4 + 1.62 respectively, P>0.05). • Regarding HR, there was statistical significant difference between sepsis and both SIRS (at admission), and control (128.3 + 13.8 vs. 112.2 + 15.7, 77.8+12.2 respectively, P >0.05) but no statistical significant difference between sepsis and SIRS (3rd day after admission) (128.3 + 13.8 vs. 114.5 +15.5 respectively, P> 0.05). • Regarding WBCS, there were statistically-significant differences between sepsis cases and controls (14922 + 12600 vs. 6070 + 1295 respectively, P >0.05) while no statistically-significant differences between septic patients and SIRS (14922 + 12600 vs. 13060 + 6240 respectively, P> 0.05). • Regarding platelets, there were statistically-significant differences between sepsis cases and controls (136000 ±9000 vs. 777878 ± 53250 respectively, P>0.05) while no statistically-significant differences between septic patients and SIRS (136000 ±9000 vs. 222100 +12900 respectively, P> 0.05). SUMMARY 103 • Regarding serum leptin level, the current study revealed a statistically significant difference in its level in sepsis cases compared to SIRS cases, and control (33.9 + 20.8 vs. 21.5+ 10.1, 1.9+ 0.4 respectively, P> 0.05). • Our study revealed the levels of serum leptin in sepsis were positively correlated with CRP, body temperature, heart rate, and WBCS. While were negatively correlated with platelets. • The current study found that serum leptin was reliable in the detection of SIRS (P 0.02) at the cut off value was < 3.4 ng\ml with 100% sensitivity & 92%specificity, while CRP was also reliable in detection of SIRS (p 8.77) but with sensitivity 77% and specificity 70% with cut off value was < 8.2mg/dl . • The current study showed that the best cut off value for serum leptin in the detection of sepsis was <5.9 ng/ml with a sensitivity of 98% and a specificity of 97% and the best cut off value of CRP in the detection of sepsis was < 78.7mg\dl ml with a sensitivity of 85% and a specificity of 80%. In present study, leptin was found to have sensitivity and specificity in diagnosing sepsis more than CRP and area under the curve for leptin (0.88) was significantly higher than CRP(0.62) , suggesting that leptin is not only an adipostatic hormone but also a sepsis-related hormone and, it seems to be more reliable marker of pediatric early sepsis diagnosis. so, we recommend measurement of serum leptin level early on suspicion of sepsis which may aid in confirming the sepsis diagnosis and add serum leptin in sepsis diagnostic panel . However, prospective multi-center studies should be done to confirm the association between early high serum leptin level and pediatric sepsis.