The role of angiogenic factors in predicting clinical outcome in severe bacterial infection in Malawian children.
Abstract | INTRODUCTION: METHODS: In 293 children with severe bacterial infection, plasma VEGF, PDGF, FGF, and Ang-1 and Ang-2 were measured on admission; in 50 of the children with meningitis, VEGF, PDGF, and FGF were also measured in the CSF. Healthy controls comprised children from some of the villages of the index cases. Univariable and multivariable logistic regression analyses were performed to develop a prognostic model. RESULTS: The median age was 2.4 years, and the IQR, 0.7 to 6.0 years. There were 211 children with bacterial meningitis (72%) and 82 (28%) with pneumonia, and 154 (53%) children were HIV infected. Mean VEGF, PDGF, and FGF concentrations were higher in survivors than in nonsurvivors, but only PDGF remained significantly increased in multivariate analysis (P = 0.007). Mean Ang-1 was significantly increased, and Ang-2 was significantly decreased in survivors compared with nonsurvivors (6,000 versus 3,900 pg/ml, P = 0.03; and 7,700 versus 11,900 pg/ml, P = 0.02, respectively). With a logistic regression model and controlling for confounding factors, only female sex (OR, 3.95; 95% CI, 1.33 to 11.76) and low Ang-1 (OR, 0.23; 95% CI, 0.08 to 0.69) were significantly associated with mortality. In children with bacterial meningitis, mean CSF VEGF, PDGF, and FGF concentrations were higher than paired plasma concentrations, and mean CSF, VEGF, and FGF concentrations were higher in nonsurvivors than in survivors (P = 0.02 and 0.001, respectively). CONCLUSIONS: Lower plasma VEGF, PDGF, FGF, and Ang-1 concentrations and higher Ang-2 concentrations are associated with an unfavorable outcome in children with severe bacterial infection. These angiogenic factors may be important in the endothelial dysregulation seen in severe bacterial infection, and they could be used as biomarkers for the early identification of patients at risk of a poor outcome.
|
Authors | Limangeni A Mankhambo, Daniel L Banda, IPD Study Group, Graham Jeffers, Sarah A White, Paul Balmer, Standwell Nkhoma, Happy Phiri, Elizabeth M Molyneux, C Anthony Hart, Malcolm E Molyneux, Robert S Heyderman, Enitan D Carrol |
Journal | Critical care (London, England)
(Crit Care)
Vol. 14
Issue 3
Pg. R91
( 2010)
ISSN: 1466-609X [Electronic] England |
PMID | 20492647
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
|
Chemical References |
- Angiogenic Proteins
- Angiopoietins
- Biomarkers
|
Topics |
- Angiogenic Proteins
(blood, cerebrospinal fluid, metabolism)
- Angiopoietins
(blood, metabolism)
- Bacterial Infections
(metabolism, mortality, physiopathology)
- Biomarkers
(blood)
- Child
- Child, Preschool
- Female
- Humans
- Infant
- Malawi
- Male
- Multivariate Analysis
- Predictive Value of Tests
- Severity of Illness Index
- Treatment Outcome
|
|
Join CureHunter, for free Research Interface BASIC access!
Take advantage of free CureHunter research engine access to explore the best drug and treatment options for any disease.
Find out why thousands of doctors, pharma researchers and patient activists
around the world use CureHunter every day.
Realize the full power of the drug-disease research graph!
|