Abstract PCCLB-26: INSIGHTS INTO MALARIAL AND NON-MALARIAL SEPSIS: BIOMARKER PROFILES IN MALAWIAN CHILDREN

Abstract

Aims & Objectives: Sepsis is a complex interplay between the infectious agent and host response. Biomarker analyses can elucidate this dynamic relationship, but little is known about pediatric biomarker profiles in sub-Saharan Africa (SSA). We aimed to characterize the biomarker profile of 1) children with and without sepsis and 2) with malarial and non-malarial sepsis (NMS) in Malawi. Methods This is a cohort study of children (aged 6–60 mo) at a community health center in Blantyre (January-August 2016). We measured serum pro-inflammatory (interleukin-6 [IL], tumor necrosis factor receptor-1 [TNF R1]), anti-inflammatory (IL-10, IL-1β) and endothelial injury (vonWillebrand factor antigen-2 [vWFA2], intercellular adhesion molecule-1 [ICAM-1], angiopoietin-2 [Ang-2]) biomarkers at presentation. We used StataMP 14.2 for data analysis; a probability <0.05 was considered statistically significant. Results We compared 33 patients with sepsis (by systemic inflammatory response criteria) to 54 children with simple fever and 36 afebrile controls. Patient characteristics and presenting symptoms were similar between subgroups. IL-6, TNF R1, IL-10, IL-1β, and Ang-2 were elevated in children with sepsis as compared to children without sepsis (Table 1). Children with malarial sepsis compared to NMS had significantly elevated IL-6 and IL-10 and decreased IL-1β (Table 2). IL-10 predicted sepsis the best with an area under the receiver operator characteristic of 0.67. Conclusions Sepsis is a heterogeneous clinical entity. Septic children in Malawi had a distinct biomarker profile compared to controls and sepsis etiology influenced the host response. Regional clinical and biological data from SSA are necessary to explore sepsis pathophysiology in this population.