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Pediatr Int. 2016 Mar;58(3):185-91. doi: 10.1111/ped.12765. Epub 2015 Nov 6.

Urinary L-FABP as a mortality predictor in <5-year-old children with sepsis in Bangladesh.

Author information

1
Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
2
Department of Clinical Trial and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
3
Department of Epidemiology and Clinical Research, Research Institute of Tuberculosis, Tokyo, Japan.
4
CMIC, Tokyo, Japan.
5
Centre for Nutrition and Food Security, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.

Abstract

BACKGROUND:

Although sepsis is often associated with high mortality in severely malnourished children, data are very limited on appropriate diagnostic tools to predict mortality. We examined the role of urinary liver-type fatty acid-binding protein (L-FABP) in children <5 years old with sepsis who died.

METHODS:

This prospective observational study was conducted at the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh. Children aged 6-59 months admitted with sepsis from April 2010 to December 2011 were enrolled. Comparison of clinical and laboratory characteristics was made between children who survived (n = 83) and those who did not survive (n = 22).

RESULTS:

On multiple Poisson regression analysis, after adjusting for potential confounders such as mid-upper arm circumference < 115 mm, plasma albumin < 2.5 g/dL, potassium > 5.0 mmol/L, and blood urea nitrogen > 20 mg/dL on admission, first urine L-FABP ≥ 370 ng/mL (relative risk [RR], 2.76; 95%CI: 1.22-6.25), weight-for-length/height z score < -3 (RR, 2.54; 95%CI: 1.26-5.09), capillary refilling time > 2.0 s (RR, 5.16; 95%CI: 1.46-18.3), and sodium > 160 mmol/L (RR, 2.72; 95%CI: 1.07-6.90) were identified as significant risk factors of mortality in children with sepsis. Diagnostic performance of first urine L-FABP was analyzed using receiver operating characteristic curve, and the area under the curve was 0.647 (95%CI: 0.500-0.795).

CONCLUSION:

Urinary L-FABP may be a useful predictor of mortality in septic children. Urinary examination is non-invasive and easy to apply at the bedside.

KEYWORDS:

case fatality; mortality; sepsis; severe acute malnutrition; urinary liver-type fatty acid-binding protein

PMID:
26214495
DOI:
10.1111/ped.12765
[Indexed for MEDLINE]

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