title: Urinary L-FABP as a mortality predictor in <5-year-old children with sepsis in Bangladesh.
abstract: BACKGROUND
  Although sepsis is often associated with high mortality in severely malnourished children, data are very limited on appropriate diagnostic tools to predict mortality. We examined the role of urinary liver-type fatty acid-binding protein (L-FABP) in children <5 years old with sepsis who died.
  
  
  METHODS
  This prospective observational study was conducted at the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh. Children aged 6-59 months admitted with sepsis from April 2010 to December 2011 were enrolled. Comparison of clinical and laboratory characteristics was made between children who survived (n = 83) and those who did not survive (n = 22).
  
  
  RESULTS
  On multiple Poisson regression analysis, after adjusting for potential confounders such as mid-upper arm circumference < 115 mm, plasma albumin < 2.5 g/dL, potassium > 5.0 mmol/L, and blood urea nitrogen > 20 mg/dL on admission, first urine L-FABP ≥ 370 ng/mL (relative risk [RR], 2.76; 95%CI: 1.22-6.25), weight-for-length/height z score < -3 (RR, 2.54; 95%CI: 1.26-5.09), capillary refilling time > 2.0 s (RR, 5.16; 95%CI: 1.46-18.3), and sodium > 160 mmol/L (RR, 2.72; 95%CI: 1.07-6.90) were identified as significant risk factors of mortality in children with sepsis. Diagnostic performance of first urine L-FABP was analyzed using receiver operating characteristic curve, and the area under the curve was 0.647 (95%CI: 0.500-0.795).
  
  
  CONCLUSIONS
  Urinary L-FABP may be a useful predictor of mortality in septic children. Urinary examination is non-invasive and easy to apply at the bedside.
authors.affiliation: Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.|Department of Clinical Trial and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.|Department of Epidemiology and Clinical Research, Research Institute of Tuberculosis, Tokyo, Japan.
authors.forename: Shoji
authors.initials: S
authors.lastname: Yoshimatsu
authors.affiliation: CMIC, Tokyo, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Sugaya
authors.affiliation: Centre for Nutrition and Food Security, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Md Iqbal
authors.initials: MI
authors.lastname: Hossain
authors.affiliation: Centre for Nutrition and Food Security, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: M Munirul
authors.initials: MM
authors.lastname: Islam
authors.affiliation: Centre for Nutrition and Food Security, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Mohammod Jobayer
authors.initials: MJ
authors.lastname: Chisti
authors.affiliation: Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Kamoda
authors.affiliation: Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Fukushima
authors.affiliation: Department of Clinical Trial and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Wagatsuma
authors.affiliation: Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Sumazaki
authors.affiliation: Centre for Nutrition and Food Security, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Tahmeed
authors.initials: T
authors.lastname: Ahmed
mesh_terms: D001459:Bangladesh / Q000453:epidemiology; D015415:Biomarkers / Q000652:urine; D002675:Child, Preschool; D018450:Disease Progression; D050556:Fatty Acid-Binding Proteins / Q000652:urine*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D018805:Sepsis / Q000401:mortality / Q000652:urine*; D015996:Survival Rate / Q000639:trends
chemical_list: D015415:Biomarkers; C493319:FABP1 protein, human; D050556:Fatty Acid-Binding Proteins
keywords: case fatality; mortality; sepsis; severe acute malnutrition; urinary liver-type fatty acid-binding protein