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Published on: June 28, 2018
Heparin-Binding Protein Stratifies Mortality Risk Among Ugandan Children Hospitalized With Respiratory Distress
Hridesh Mishra1, Núria Balanza2, Caroline Francis1
1Sandra A. Rotman Laboratories, Sandra Rotman Centre for Global Health, University Health Network-Toronto General Hospital, Toronto, Ontario, Canada.
Insights
Heparin-binding protein (HBP) can identify children with pneumonia at risk of death. Measuring HBP at hospital admission improves risk assessment and could aid in early recognition of severe pediatric pneumonia.
Area of Science:
- Pediatric infectious diseases
- Biomarker discovery
- Clinical risk stratification
Background:
- Current prognostic tools for childhood pneumonia lack reliability and objectivity.
- Heparin-binding protein (HBP) is an immune protein released during infection.
- HBP may help identify children with pneumonia at risk of severe outcomes.
Purpose of the Study:
- To evaluate the prognostic accuracy of HBP for in-hospital mortality in children with respiratory distress.
- To determine if HBP improves existing clinical severity scores for pneumonia risk stratification.
Main Methods:
- Assessed HBP concentrations in 778 Ugandan children under 5 with pneumonia.
- Compared HBP levels between children with fatal and non-fatal outcomes.
- Utilized receiver operating characteristic (ROC) curve analysis to evaluate HBP's predictive accuracy.
Main Results:
- 60 (7.7%) children died during admission.
- HBP levels were significantly higher in children with fatal outcomes (median 76 ng/mL vs. 31 ng/mL).
- HBP >41 ng/mL indicated elevated death risk (HR 5.3); HBP improved the Respiratory Index of Severity in Children score (AUC 0.75).
Conclusions:
- HBP measurement at presentation aids in identifying children with severe or fatal pneumonia.
- Integrating HBP into clinical scores can enhance recognition and triage of high-risk pediatric pneumonia cases.
Background:
Current prognostic tools do not reliably and objectively identify children with pneumonia at risk of a severe or life-threatening episode. Heparin-binding protein (HBP) is a host immune protein that is released in response to infection. We hypothesized that measuring HBP concentrations at hospital admission could help risk-stratify children with pneumonia and identify those at higher risk of an adverse prognosis.
Methods:
We evaluated the prognostic accuracy of HBP for predicting in-hospital mortality among children with respiratory distress, and whether HBP could improve the accuracy of validated composite clinical severity scores.
Results:
Of 778 Ugandan children under 5 years of age and presenting with clinically defined pneumonia, 60 (7.7%) died during hospital admission. HBP concentrations at presentation were significantly higher in children with fatal outcomes (median, 76 ng/mL [interquartile range {IQR}, 41-150]) compared to children who survived (median, 31 ng/mL [IQR, 18-57]) (P < .001). Children with HBP >41 ng/mL on admission had an elevated risk of death (hazard ratio, 5.3 [95% confidence interval {CI}, 2.9-9.5]; P < .0001). In receiver operating characteristic (ROC) curve analysis, HBP concentrations distinguished between fatal and nonfatal outcomes (area under the ROC curve, 0.75 [95% CI, .66-.84]) and significantly improved the prediction provided by the Respiratory Index of Severity in Children, a composite clinical severity score (P = .0026).
Conclusions:
Measuring HBP at presentation could help identify children at risk of severe and fatal pneumonia. Adding HBP to clinical scores could improve the recognition and triage of children with pneumonia at risk of death.
