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Elevated Levels of PDGF-BB and VEGF Are Associated With a Decreased Risk of Readmission or Death in Children With
Mary G Slaughter1, Samina Bhumbra1, Kagan A Mellencamp1
1Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Insights
Children with severe malarial anemia have a high risk of readmission or death. Elevated levels of platelet-derived growth factor-BB (PDGF-BB) and vascular endothelial growth factor (VEGF) are linked to a lower risk of readmission or death.
Area of Science:
- Pediatrics
- Tropical Medicine
- Hematology
Background:
- Children with severe malarial anemia (SMA) face significant risks of readmission and mortality post-discharge.
- Dysregulation in hematopoiesis, vascular growth factors, and endothelial function may contribute to these adverse outcomes.
Purpose of the Study:
- To investigate the association between specific biomarkers in children with SMA and their risk of readmission or death within 12 months.
- To determine if markers of hematopoiesis, vascular growth, and endothelial function predict post-discharge outcomes in pediatric SMA patients.
Main Methods:
- Plasma samples were collected from 145 children (18 months to 12 years) with SMA upon admission in Kampala, Uganda.
- Levels of 10 biomarkers were measured and correlated with 12-month follow-up outcomes, including readmission and mortality.
Main Results:
- Elevated admission plasma levels of platelet-derived growth factor-BB (PDGF-BB) and vascular endothelial growth factor (VEGF) were independently associated with a reduced risk of readmission or death.
- These growth factors significantly decreased the risk of readmission due to severe malaria, but not uncomplicated malaria.
Conclusions:
- Higher plasma PDGF-BB and VEGF levels in children with SMA are protective against readmission and death within a year post-discharge.
- Angiogenic factors PDGF-BB and VEGF appear to mitigate the risk of recurrent severe malaria, improving overall outcomes.
Background:
Children with severe malarial anemia (SMA) typically have low in-hospital mortality but have a high risk of postdischarge readmission or death. We hypothesized that the dysregulation of hematopoiesis, vascular growth factors, and endothelial function that occurs in SMA might affect risk of readmission or death.
Methods:
Plasma was obtained from children 18 months to 12 years old with SMA (n = 145) in Kampala, Uganda on admission, and outcomes were assessed over 12-month follow-up. Admission plasma levels of 10 biomarkers of vascular growth, hematopoiesis, and endothelial function were compared to risk of readmission or death over 12-month follow-up.
Results:
Over 12-month follow-up, 19 of 145 children with SMA were either readmitted or died: 15 children were readmitted (13 with malaria) and 4 children died. In multivariable analyses adjusted for age and sex, elevated plasma levels of platelet-derived growth factor-BB (PDGF-BB) and vascular endothelial growth factor (VEGF) on admission were independently associated with a decreased risk of all-cause readmission or death (adjusted hazard ratios [95% confidence intervals], 0.28 [.16-.51] and 0.19 [.08-.48], respectively) and a decreased risk of readmission due to severe malaria (0.27 [.15-.51] and 0.16 [.05-.47]) but not with risk of uncomplicated malaria (1.01 [.53-1.95] and 2.07 [.93-4.64]).
Conclusions:
In children with severe malarial anemia, elevated plasma levels of PDGF-BB and VEGF, 2 factors that promote angiogenesis, are associated with a decreased risk of readmission or death in the year following admission, primarily driven by a decrease in the risk of recurrent severe malaria.
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