Persistent immune, coagulation and cardiac dysregulation are correlated with later post-discharge mortality in children with severe malnutrition
Rattachement africain : Kenya, nl, gb, kh. Niveau de preuve : code pays fourni par la source.
Le résumé fourni par la source
BACKGROUND: Children with complicated severe malnutrition (CSM) face high mortality after hospital discharge, yet the underlying mechanisms remain poorly understood. While early post-discharge mortality (< 2 months) has been linked to a sepsis-like inflammatory profile measured at discharge, it is unclear whether this relationship persists (later mortality; 2-6 months post-discharge). This study investigated whether immune, inflammatory, and endothelial dysfunction at 2 months post-discharge are associated with later mortality in children recovering from CSM. METHODS: We conducted a case-control study nested within a randomised placebo-controlled trial of daily co-trimoxazole in HIV-negative children aged 2-59 months with CSM in four Kenyan hospitals. Cases were children who died between 2 and 6 months post-discharge; controls were survivors frequency-matched by sex, site, and trial arm. Plasma cytokines, chemokines, endothelial markers, and untargeted proteomics were measured at discharge and 2 months post-discharge. Conditional Cox regression, adjusted for age, sex, site, mid-upper arm circumference (MUAC), and randomisation arm, was used to identify biomarkers associated with later mortality. RESULTS: Cases were younger (had a median of 7 vs. 11 months), had longer hospital stays (14 vs. 10 days), and showed lower anthropometry (MUAC = 10.7 vs. 12.0 cm) and lower haemoglobin (9.7 vs. 10.6 g/dL) at 2 months post-discharge (all p < 0.05). Mortality 2-6 months post-discharge was associated with elevated inflammatory mediators (e.g. IL-10 [hazard ratio, HR: 1.47, 95% confidence interval, CI: 1.00-2.14], IL-15 [1.65, 95% CI: 1.08-2.51], IFN-α2 [1.51, 95% CI: 1.02-2.23]), acute phase proteins, apolipoproteins and coagulation markers, including fibrinogen, histidine-rich glycoprotein (1.40, 95% CI: 1.01-1.94), protein C inhibitor (SERPINA5, 1.50, 95% CI: 1.07-2.08), SERPINA10 (1.42, 95% CI: 1.02-1.99), and ADAMTS13 (0.41, 95% CI: 0.24-0.70). Additionally, cardiovascular and muscle-related proteins such as angiotensinogen (1.46, 95% CI: 1.03-2.08), α- and β-tropomyosin (0.68, 95% CI: 0.48-0.98), PI16 (0.72, 95% CI:0.54-0.97), and zyxin (0.61, 95% CI: 0.40-0.92) were elevated in cases. CONCLUSIONS: Later mortality in children recovering from CSM is associated with persistent immune activation, a sepsis-like phenotype involving multiple systems. These findings suggest that children at risk of later mortality may benefit from biomarker-guided interventions initiated at discharge.
Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.
Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Persistent immune, coagulation and cardiac dysregulation are correlated with later post-discharge mortality in children with severe malnutrition
- Date Crossref
- 22/01/2026
- Éditeur
- Springer Science and Business Media LLC
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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Kenya Medical Research Institute Kenya (code pays fourni par la source)Structure de recherche
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KEMRI-Wellcome Trust Research Programme Kilifi, Kenya (code pays fourni par la source)Structure de recherche
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The Childhood Acute Illness and Nutrition Network Nairobi, Kenya (code pays fourni par la source)Institution
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Wageningen University & Research pays non établi dans la noticeUniversité ou école supérieure
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Wellcome Sanger Institute pays non établi dans la noticeOrganisation à but non lucratif
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Pwani University Kilifi, Kenya (code pays fourni par la source)Université ou école supérieure
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Nairobi Hospital Nairobi Hospital, Kenya (code pays fourni par la source)Établissement de santé
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Angkor Hospital for Children pays non établi dans la noticeÉtablissement de santé
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Wellcome Trust pays non établi dans la noticeOrganisation à but non lucratif
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Wellcome/MRC Cambridge Stem Cell Institute pays non établi dans la noticeStructure de recherche
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Wageningen University and Research Division of Human Nutrition and Health pays non établi dans la noticeUniversité ou école supérieure
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Host-Microbiota Interactions Lab pays non établi dans la noticeStructure de recherche
Kenya Medical Research Institute (Kenya), KEMRI-Wellcome Trust Research Programme (Kilifi, Kenya) et The Childhood Acute Illness and Nutrition Network (Nairobi, Kenya), avec 9 autres affiliations. Pays d’affiliation : Kenya.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.