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- Title
Intestinal Injury in Ugandan Children Hospitalized With Malaria.
- Authors
Ngai, Michelle; Hawkes, Michael T; Erice, Clara; Weckman, Andrea M; Wright, Julie; Stefanova, Veselina; Opoka, Robert O; Namasopo, Sophie; Conroy, Andrea L; Kain, Kevin C
- Abstract
<bold>Background: </bold>Severe malaria is associated with multiple organ dysfunction syndrome (MODS), which may involve the gastrointestinal tract.<bold>Methods: </bold>In a prospective cohort study in Uganda, we measured markers of intestinal injury (intestinal fatty-acid binding protein [I-FABP] and zonula occludens-1 [ZO-1]) and microbial translocation (lipopolysaccharide binding protein [LBP] and soluble complement of differentiation 14 [sCD14]) among children admitted with malaria. We examined their association with biomarkers of inflammation, endothelial activation, clinical signs of hypoperfusion, organ injury, and mortality.<bold>Results: </bold>We enrolled 523 children (median age 1.5 years, 46% female, 7.5% mortality). Intestinal FABP was above the normal range (≥400 pg/mL) in 415 of 523 patients (79%). Intestinal FABP correlated with ZO-1 (ρ = 0.11, P = .014), sCD14 (ρ = 0.12, P = .0046) as well as markers of inflammation and endothelial activation. Higher I-FABP levels were associated with lower systolic blood pressure (ρ = -0.14, P = .0015), delayed capillary refill time (ρ = 0.17, P = .00011), higher lactate level (ρ = 0.40, P < .0001), increasing stage of acute kidney injury (ρ = 0.20, P = .0034), and coma (P < .0001). Admission I-FABP levels ≥5.6 ng/mL were associated with a 7.4-fold higher relative risk of in-hospital death (95% confidence interval, 1.4-11, P = .0016).<bold>Conclusions: </bold>Intestinal injury occurs commonly in children hospitalized with malaria and is associated with microbial translocation, systemic inflammation, tissue hypoperfusion, MODS, and fatal outcome.
- Subjects
UGANDA; HOSPITAL care of children; INTESTINAL injuries; SYSTOLIC blood pressure; SYMPTOMS; MALARIA; CARRIER proteins; RESEARCH funding; MULTIPLE organ failure; INTESTINAL diseases; HOSPITAL mortality; LONGITUDINAL method; INFLAMMATION; DISEASE complications
- Publication
Journal of Infectious Diseases, 2022, Vol 226, Issue 11, p2010
- ISSN
0022-1899
- Publication type
journal article
- DOI
10.1093/infdis/jiac340