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Serum Inflammatory Markers in Children with Severe Acute Malnutrition with Systemic Infections: A Case-Control Study
Naznin Parvin1, Virendra Kumar1, Praveen Kumar2
1Department of Pediatrics, Lady Hardinge Medical College & Associated Hospitals, Shaheed Bhagat Singh Marg, New Delhi, 110001, India.
Insights
Children with severe acute malnutrition (SAM) show a weaker inflammatory response to infections compared to well-nourished children. This impaired immune response in SAM impacts their recovery and susceptibility to illness.
Area of Science:
- Pediatrics
- Immunology
- Infectious Diseases
Background:
- Severe acute malnutrition (SAM) is a significant cause of mortality in children under five, particularly in India.
- SAM children exhibit increased susceptibility to infections, but the immune response during infection is not fully understood.
- Existing literature on inflammatory responses in SAM cases versus controls with infections is inconsistent.
Purpose of the Study:
- To compare serum inflammatory markers in children with SAM and systemic infections against nutritionally normal children with infections.
- To investigate the derangement of immune mechanisms and inflammatory responses in SAM.
- To correlate inflammatory markers with treatment duration.
Main Methods:
- A case-control study was conducted.
- Serum inflammatory markers (C-reactive protein [CRP], interleukin-6 [IL-6], procalcitonin) were measured in 60 SAM children and matched controls with infections.
- Statistical analysis was performed to compare marker levels and correlate them with antibiotic therapy duration.
Main Results:
- Children with SAM had significantly lower mean serum CRP on admission and follow-up compared to controls (p < 0.001).
- Mean serum IL-6 was also lower on admission in SAM cases (p = 0.04).
- Baseline and follow-up procalcitonin, along with baseline CRP, positively correlated with antibiotic therapy duration.
Conclusions:
- SAM children possess a diminished capacity to mount an inflammatory response during systemic infections.
- The inflammatory response in SAM children is weaker when compared to nutritionally normal children experiencing similar infections.
- Understanding this impaired response is crucial for managing infections in SAM populations.
Abstract:
Severe acute malnutrition (SAM) is a major contributor to under-five mortality in developing countries such as India, where SAM children are susceptible to infections. However, there is inconsistent literature on the derangement of immune mechanisms and subsequent infection-related mounting of inflammatory responses in SAM cases compared to nutritionally-normal controls with infections. To address this, authors conducted a case-control study comparing serum inflammatory markers in 60 SAM children with systemic infections to nutritionally-normal children with infection. Cases had a lower mean serum C-reactive protein (CRP) on admission compared to controls (p-value <0.001), which continued during the follow-up (p-value <0.001). Cases also had a lower mean serum interleukin-6 (IL-6) on admission (p-value = 0.04). Baseline CRP, procalcitonin, and follow-up procalcitonin were positively correlated with antibiotic therapy duration (p-value = 0.018, 0.025, and 0.007, respectively). This study suggests that SAM children had some ability to mount an inflammatory response during a systemic infection, but it was weaker compared to nutritionally normal children with a systemic infection.
