Intestinal injury in Ugandan children hospitalized with malaria

Michelle Ngai; Michael T. Hawkes; Clara Erice; Andrea M. Weckman; Julie Wright; Veselina Stefanova; Robert Opoka; Sophie Namasopo; Andrea Conroy; Kevin Kain

Intestinal injury in Ugandan children hospitalized with malaria

Michelle Ngai, Michael T. Hawkes, Clara Erice, Andrea M. Weckman, Julie Wright, Veselina Stefanova, Robert Opoka, Sophie Namasopo, Andrea Conroy, Kevin Kain

Medical College, East Africa

Research output: Contribution to journal › Article

Abstract

Background: Severe malaria is associated with multiple organ dysfunction syndrome (MODS), which may involve the gastrointestinal tract.

Methods: 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.

Results: 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

Conclusions: Intestinal injury occurs commonly in children hospitalized with malaria and is associated with microbial translocation, systemic inflammation, tissue hypoperfusion, MODS, and fatal outcome.

Original language	Undefined/Unknown
Journal	Paediatrics and Child Health, East Africa
Publication status	Published - 1 Dec 2022

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http://ecommons.aku.edu/eastafrica_fhs_mc_paediatr_child_health/243

Cite this

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title = "Intestinal injury in Ugandan children hospitalized with malaria",

abstract = "Background: Severe malaria is associated with multiple organ dysfunction syndrome (MODS), which may involve the gastrointestinal tract. Methods: 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. Results: 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 Conclusions: Intestinal injury occurs commonly in children hospitalized with malaria and is associated with microbial translocation, systemic inflammation, tissue hypoperfusion, MODS, and fatal outcome.",

author = "Michelle Ngai and Hawkes, {Michael T.} and Clara Erice and Weckman, {Andrea M.} and Julie Wright and Veselina Stefanova and Robert Opoka and Sophie Namasopo and Andrea Conroy and Kevin Kain",

year = "2022",

month = dec,

day = "1",

language = "Undefined/Unknown",

journal = "Paediatrics and Child Health, East Africa",

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TY - JOUR

T1 - Intestinal injury in Ugandan children hospitalized with malaria

AU - Ngai, Michelle

AU - Hawkes, Michael T.

AU - Erice, Clara

AU - Weckman, Andrea M.

AU - Wright, Julie

AU - Stefanova, Veselina

AU - Opoka, Robert

AU - Namasopo, Sophie

AU - Conroy, Andrea

AU - Kain, Kevin

PY - 2022/12/1

Y1 - 2022/12/1

N2 - Background: Severe malaria is associated with multiple organ dysfunction syndrome (MODS), which may involve the gastrointestinal tract. Methods: 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. Results: 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 Conclusions: Intestinal injury occurs commonly in children hospitalized with malaria and is associated with microbial translocation, systemic inflammation, tissue hypoperfusion, MODS, and fatal outcome.

AB - Background: Severe malaria is associated with multiple organ dysfunction syndrome (MODS), which may involve the gastrointestinal tract. Methods: 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. Results: 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 Conclusions: Intestinal injury occurs commonly in children hospitalized with malaria and is associated with microbial translocation, systemic inflammation, tissue hypoperfusion, MODS, and fatal outcome.

M3 - Article

JO - Paediatrics and Child Health, East Africa

JF - Paediatrics and Child Health, East Africa

ER -