Host-Based Prognostic Biomarkers to Improve Risk Stratification and Outcome of Febrile Children in Low- and Middle-Income Countries.
Host-Based Prognostic Biomarkers to Improve Risk Stratification and Outcome of Febrile Children in Low- and Middle-Income Countries.
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DOI：
10.3389/fped.2020.552083
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发表时间：
2020
影响因子：
2.6
通讯作者：
Bassat Q
中科院分区：
文献类型：
--
作者：
Balanza N;Erice C;Ngai M;Varo R;Kain KC;Bassat Q
发热是儿科医疗咨询的主要原因之一，也是低收入和中等收入国家（LMIC）临床表现中最常见的症状。大多数发热事件是由于自限性感染，但一小部分儿童会发展为危及生命的感染。在所有发热病例中，早期识别患有或正在发展为危重病的儿童具有挑战性，目前没有客观和定量的工具来做到这一点。这导致即将发生危及生命的感染的儿童的发病率和死亡率增加，同时导致不必要的抗生素处方，使卫生保健设施不堪重负，并对接受可避免的抗菌治疗的患者造成伤害。具体的发热原因难以确定，在中低收入国家合并感染很常见。然而，许多严重感染共享宿主损伤的共同途径，无论病因如何，包括促成脓毒症的病理生物学的免疫和内皮活化（即，疾病的病原体“不可知”机制）。重要的是，这些通路的介质是疾病严重程度和结果的独立标志物。我们建议，测量这些因素的循环水平可以提供定量和客观的证据：使早期识别严重感染;指导患者分诊和管理;加强出院后风险分层和随访;减轻临床决策中潜在的性别偏见。在这里，我们回顾了支持宿主免疫和内皮激活生物标志物作为新型快速分诊测试组件的临床实用性的临床和生物学证据，并讨论了开发和实施此类工具的挑战和需求。
Fever is one of the leading causes for pediatric medical consultation and the most common symptom at clinical presentation in low- and middle-income countries (LMICs). Most febrile episodes are due to self-limited infections, but a small proportion of children will develop life-threatening infections. The early recognition of children who have or are progressing to a critical illness among all febrile cases is challenging, and there are currently no objective and quantitative tools to do so. This results in increased morbidity and mortality among children with impending life-threatening infections, whilst contributing to the unnecessary prescription of antibiotics, overwhelming health care facilities, and harm to patients receiving avoidable antimicrobial treatment. Specific fever origin is difficult to ascertain and co-infections in LMICs are common. However, many severe infections share common pathways of host injury irrespective of etiology, including immune and endothelial activation that contribute to the pathobiology of sepsis (i.e., pathogen “agnostic” mechanisms of disease). Importantly, mediators of these pathways are independent markers of disease severity and outcome. We propose that measuring circulating levels of these factors can provide quantitative and objective evidence to: enable early recognition of severe infection; guide patient triage and management; enhance post-discharge risk stratification and follow up; and mitigate potential gender bias in clinical decisions. Here, we review the clinical and biological evidence supporting the clinical utility of host immune and endothelial activation biomarkers as components of novel rapid triage tests, and discuss the challenges and needs for developing and implementing such tools.
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影响因子：
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作者：
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DOI：
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