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The pattern recognition molecule collectin-L1 in critically ill children
Catherine Ingels1, Ilse Vanhorebeek1, Inge Derese1
1Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, Leuven, Belgium.
Insights
High collectin-L1 (CL-L1) levels in critically ill children predict increased infection risk and longer intensive care stays, contrary to expectations. Low MASP-3 levels, however, still indicate higher risk.
Area of Science:
- Immunology
- Pediatric Critical Care
- Complement System
Background:
- Critically ill children face high risks of nosocomial infections.
- Low mannan-binding lectin-associated serine protease (MASP)-3 concentrations are linked to infection risk and prolonged PICU stays.
- Collectin-L1 (CL-L1) is a novel protein in the lectin pathway.
Purpose of the Study:
- To investigate the association between serum collectin-L1 (CL-L1) concentrations and adverse outcomes in critically ill children.
- To determine if CL-L1 independently predicts infection risk and PICU length of stay.
Main Methods:
- Serum CL-L1 concentrations were measured in 700 critically ill children and 81 healthy children.
- Statistical analyses were performed, adjusting for baseline characteristics, risk factors, and other lectin pathway proteins.
Main Results:
- Critically ill children had significantly lower CL-L1 concentrations than healthy children.
- Higher CL-L1 concentrations were independently associated with increased risk of new infections and prolonged PICU discharge time.
- Low MASP-3 concentrations remained independently associated with adverse outcomes.
Conclusions:
- Elevated serum CL-L1 upon PICU admission is paradoxically linked to increased infection risk and longer intensive care duration.
- High CL-L1 may counteract the protective effects of high MASP-3 concentrations.
- These findings highlight a complex role for CL-L1 in pediatric critical illness.
Background:
Critically ill children are prone to nosocomial infections, which may lead to adverse outcome. Low serum concentrations upon admission to the pediatric intensive care unit (PICU) of the mannan-binding lectin (MBL)-associated serine protease (MASP)-3 protein of the lectin pathway of complement activation have been associated with risk of infection and prolonged need for intensive care. We hypothesized that also a low upon-admission concentration of collectin-L1 (CL-L1), a novel member of this pathway, is independently associated with these adverse outcomes.
Methods:
We quantified the serum concentrations of CL-L1 in 81 healthy children and in 700 critically ill children upon PICU admission.
Results:
CL-L1 concentrations were significantly lower in the critically ill children as compared with the healthy children. However, corrected for baseline characteristics, risk factors and several lectin pathway proteins, a higher CL-L1 concentration upon PICU admission was independently associated with an increased risk of acquiring a new infection and with a prolonged time to PICU discharge. In contrast, a low MASP-3 concentration remained independently associated with these adverse outcomes.
Conclusion:
A high serum CL-L1 concentration in critically ill children upon PICU admission is associated with an increased risk of infection and prolonged need of intensive care, and counteracts the protective effect of having a high MASP-3 concentration.
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