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sTREM-1: A Biomarker of Mortality in Severe Malaria Impacted by Acute Kidney Injury.
Mufumba, Ivan; Kazinga, Caroline; Namazzi, Ruth; Opoka, Robert O; Batte, Anthony; Bond, Caitlin; John, Chandy C; Conroy, Andrea L.
Afiliação
  • Mufumba I; CHILD Laboratory, Global Health Uganda, Kampala, Uganda.
  • Kazinga C; CHILD Laboratory, Global Health Uganda, Kampala, Uganda.
  • Namazzi R; CHILD Laboratory, Global Health Uganda, Kampala, Uganda.
  • Opoka RO; Department of Pediatrics, Makerere University College of Health Sciences, Kampala, Uganda.
  • Batte A; CHILD Laboratory, Global Health Uganda, Kampala, Uganda.
  • Bond C; Department of Pediatrics, Makerere University College of Health Sciences, Kampala, Uganda.
  • John CC; CHILD Laboratory, Global Health Uganda, Kampala, Uganda.
  • Conroy AL; Child Health and Development Center, Makerere University College of Health Sciences, Kampala, Uganda.
J Infect Dis ; 229(4): 936-946, 2024 Apr 12.
Article em En | MEDLINE | ID: mdl-38078677
BACKGROUND: Malaria is an important cause of mortality in African children. Identification of biomarkers to identify children at risk of mortality has the potential to improve outcomes. METHODS: We evaluated 11 biomarkers of host response in 592 children with severe malaria. The primary outcome was biomarker performance for predicting mortality. Biomarkers were evaluated using receiver operating characteristic (ROC) curve analysis comparing the area under the ROC curve (AUROC). RESULTS: Mortality was 7.3% among children in the study with 72% of deaths occurring within 24 hours of admission. Among the candidate biomarkers, soluble triggering receptor expressed on myeloid cells 1 (sTREM-1) had the highest AUROC (0.78 [95% confidence interval, .70-.86]), outperforming several other biomarkers including C-reactive protein and procalcitonin. sTREM-1 was the top-performing biomarker across prespecified subgroups (malaria definition, site, sex, nutritional status, age). Using established cutoffs, we evaluated mortality across sTREM-1 risk zones. Among children with acute kidney injury, 39.9% of children with a critical-risk sTREM-1 result had an indication for dialysis. When evaluated relative to a disease severity score, sTREM-1 improved mortality prediction (difference in AUROC, P = .016). CONCLUSIONS: sTREM-1 is a promising biomarker to guide rational allocation of clinical resources and should be integrated into clinical decision support algorithms, particularly when acute kidney injury is suspected.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Injúria Renal Aguda / Malária Limite: Child / Humans Idioma: En Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Injúria Renal Aguda / Malária Limite: Child / Humans Idioma: En Ano de publicação: 2024 Tipo de documento: Article