Abstract
Paediatrician, authority on sepsis, and influential researcher in critical care medicine. Born in Havana, Cuba, on March 6, 1963 he died near Asheville, NC, USA, on Jan 23, 2022 aged 58 years. Researchers in paediatric medicine usually follow the leads set by their counterparts in adult medicine. Hector Wong, Professor of Pediatrics at the University of Cincinnati School of Medicine and Vice Chair of the Department of Pediatrics at Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, OH, USA, upended that generalisation. In critical care medicine, he was a researcher who broke new ground in the care of adults as well as children by devising a treatment plan for severe sepsis based on his own laboratory and clinical findings. Physicians dealing with adults found themselves looking to him for new insights into the condition. “Sepsis is a heterogeneous disorder”, says Brian Varisco, Associate Professor of Pediatrics in the Division of Critical Care Medicine at CCHMC. “Hector wanted to find out what was going on at a molecular level.” Wong investigated the differences in outcome among children with sepsis and the early identification of those likely to fare the worst. The recognition that gene activity had a key role led him into genomics. Gene expression profiling on every child coming into the hospital with sepsis is impracticable. “So he did a wide profiling of proteins that were most differentially expressed [in patients], and narrowed them down to just five that best predicted the various outcomes,” explains Varisco. The presence or absence of these biomarkers indicates the patient's risk of dying, or of developing multiorgan dysfunction. “The idea is that you figure out which are the high risk patients that you treat more aggressively or you allocate to [research] studies. You don’t want to subject a low risk patient to a potentially dangerous therapy.” “Wong was a very early researcher in omics work in sepsis”, says Tim Sweeney, Chief Executive Officer of Inflammatix, a molecular diagnostics company for which Wong acted as an adviser. “What set him apart was that while many people published one omics paper and then moved on, Hector built up a huge body of work.” The multi-institutional clinical and biological database Wong compiled has proved valuable in paediatric sepsis research. Sweeney, who shares Wong's fascination with immunobiology, points to his studies on hydrocortisone. The use of this agent in paediatric sepsis has long been controversial. “He took a set of biomarkers and determined which children with sepsis might respond appropriately to hydrocortisone therapy”, Sweeney explains. “I think this will be a large component of his legacy in understanding the immunobiology of sepsis.” Complementary to Wong's achievements as a scientist were his skills as a clinician. “He had an unbelievable ability to synthesise facts at the bedside”, says Patrick Kochanek, Distinguished Professor of Critical Care Medicine at the University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. Wong was “amazingly calm at the bedside”, but also able to think on his feet, to make key decisions at speed. “He was the person you’d want taking care of your kid if they were critically ill…he had a natural talent for it.” Another part of Wong's legacy was his contribution to the 2020 Surviving Sepsis Campaign guidelines for dealing with sepsis in children. Born in Cuba to Chinese parents who had left their home country after the Communist revolution, another such political upheaval prompted Wong's parents to move again, this time to the USA, when Wong was a young child. He lived first in Miami, later moving north to study biology at Bucknell University in Lewisburg, PA, before enrolling at the then University of Medicine and Dentistry of New Jersey in Newark. He graduated in 1989, worked as an intern and a resident in the Children's National Hospital in Washington, DC, and, in 1992, took up the first of two fellowships at the University of Pittsburgh School of Medicine. Appointed Assistant Professor of Pediatrics at CCHMC in 1995, Wong became a full professor there in 2005. “He always questioned the underlying premises and assumptions that we have about diseases,” Varisco says. “But he always listened…he was seldom the first to speak. He always brought people along with him. He was a good mentor.” Kochanek agrees: “A major contributor to paediatric clinical care…A great leader.” The research community will feel his loss very keenly, adds Sweeney. “But [Wong's] real passion was in trying to do better by the kids that he cared for in the intensive care unit.” Wong leaves a wife, Sue Poynter, Director of CCHMC's Pediatric Residency Training Program, and children Caroline, Ellie, Madeleine, and Max.
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