The Surviving Sepsis Campaign 2026 Guidelines Do Not Address Ferritin
There are no 2026 Surviving Sepsis Campaign guidelines for adult sepsis management, and the most recent adult guidelines (2016) do not include any recommendations regarding ferritin measurement or use in sepsis. The evidence provided only contains the 2016 Surviving Sepsis Campaign guidelines 1, 2, 1, 2, 1, which make no mention of ferritin in their recommendations.
What the Guidelines Actually Say
The 2016 Surviving Sepsis Campaign guidelines focus on:
- Initial resuscitation with crystalloid fluids (30 mL/kg within 3 hours)
- Early antimicrobial therapy (within 1 hour)
- Vasopressor support targeting MAP ≥65 mmHg
- Source control
- Nutritional support recommendations
Notably absent from these guidelines is any recommendation about measuring or using ferritin levels for diagnosis, prognosis, or treatment decisions in sepsis.
Pediatric Guidelines Context
The 2026 pediatric Surviving Sepsis Campaign guidelines 3 introduce updates for children but do not specifically address ferritin measurement as a recommended biomarker. The pediatric guidelines emphasize lactate measurement at initial assessment, but ferritin is not mentioned as part of the core recommendations.
The Evidence Gap
While recent research demonstrates that:
- Elevated ferritin (>504-828 ng/mL) correlates with increased mortality in sepsis 4, 5, 6
- Ferritin combined with other markers may improve prognostic accuracy 7, 5
- Hyperferritinemia (≥4420 ng/mL) defines macrophage activation-like syndrome (MALS) with worse outcomes 4
These findings have not yet been incorporated into official Surviving Sepsis Campaign recommendations. The guidelines remain focused on established interventions with stronger evidence for mortality reduction.
Clinical Implications
In the absence of guideline recommendations, ferritin measurement in sepsis remains a clinical judgment decision rather than a standard of care. The research suggests potential utility for risk stratification, but this has not translated into actionable treatment algorithms endorsed by the Surviving Sepsis Campaign.