Risk stratification of childhood infection using host markers of immune and endothelial activation in Asia (Spot Sepsis): a multi-country, prospective, cohort study

作者：Arjun Chandna, Arjun Chandna, Constantinos Koshiaris, Raman Mahajan, Riris Adono Ahmad, Dinh Thi Van Anh, Khalid Shams Choudhury, Suy Keang, Phung Nguyen The Nguyen, Sayaphet Rattanavong, Souphaphone Vannachone, Mohammad Yazid Abdad, Riris Andono Ahmad, Dinh Thi Van Anh, Eggi Arguni, Elizabeth A Ashley, Elizabeth M Batty, Latsaniphone Boutthasavong, Sakib Burza, Arjun Chandna, Arjun Chandna, Ngoun Chanpheaktra, Khalid Shams Choudhury, Tran Quoc Dat, Vu Quoc Dat, Nicholas P J Day, Arjen M Dondorp, Prakash Ghosh, Carolina Jimenez, Kevin Kain, Muhammad Karyana, Suy Keang, Sommay Keomany, Rungnapa Khamboocha, Constantinos Koshiaris, Khamfong Kunlaya, Estrella Lasry, Bui Thanh Liem, Nguyen Huy Luan, Yoel Lubell, Raman Mahajan, Saysamone Malavong, Mayfong Mayxay, Chonticha Menggred, Dinesh Mondal, Phung Nguyen The Nguyen, Rafael Perera-Salazar, Chom Phaiphichit, Chanthala Phamisith, Phan Hữu Phúc, Tiengkham Pongvongsa, Sayaphet Rattanavong, Michael Rekart, Melissa Richard-Greenblatt, Bran Sambou, Mohammad Shomik, Phouthalavanh Souvannasing, Phattaranit Tanunchai, Janjira Thaipadungpanit, Watcharintorn Thongpiam, Bang Huyen Tran, Claudia Turner, Paul Turner, Souphaphone Vannachone, Asama Vinitsorn, Ranitha Vongpromek, Manivanh Vongsouvath, Naomi Waithira, James A Watson, Mikhael Yosia, Asri Yuniastuti, Mikhael Yosia, Naomi Waithira, Mohammad Yazid Abdad, Janjira Thaipadungpanit, Paul Turner, Phan Huu Phuc, Dinesh Mondal, Mayfong Mayxay, Bui Thanh Liem, Elizabeth A. Ashley, Eggi Arguni, Rafael Perera-Salazar, Melissa Richard‐Greenblatt, Yoel Lubell, Sakib Burza · 发表于：The Lancet Child & Adolescent Health · 年份：2025 · DOI：10.1016/s2352-4642(25)00183-x · 被引用次数：3 · 研究领域：Inflammation biomarkers and pathways、Sepsis Diagnosis and Treatment、Neonatal and Maternal Infections

BACKGROUND: Prognostic tools for febrile illnesses are urgently required in resource-constrained community contexts. Circulating immune and endothelial activation markers stratify risk in common childhood infections. We aimed to assess their use in children with febrile illness presenting from rural communities across Asia. METHODS: Spot Sepsis was a prospective cohort study across seven hospitals in Bangladesh, Cambodia, Indonesia, Laos, and Viet Nam that serve as a first point of contact with the formal health-care system for rural populations. Children were eligible if aged 1-59 months and presenting with a community-acquired acute febrile illness that had lasted no more than 14 days. Clinical parameters were recorded and biomarker concentrations measured at presentation. The primary outcome measure was severe febrile illness (death or receipt of organ support) within 2 days of enrolment. Weighted area under the receiver operating characteristic curves (AUC) were used to compare prognostic accuracy of endothelial activation markers (ANG-1, ANG-2, and soluble FLT-1), immune activation markers (CHI3L1, CRP, IP-10, IL-1ra, IL-6, IL-8, IL-10, PCT, soluble TNF-R1, soluble TREM1 [sTREM1], and soluble uPAR), WHO danger signs, the Liverpool quick Sequential Organ Failure Assessment (LqSOFA) score, and the systemic inflammatory response syndrome (SIRS) score. Prognostic accuracy of combining WHO danger signs and the best performing biomarker was analysed in a weighted logistic regr...