BACKGROUND: Sepsis is still leading cause of death in critically ill children. Early recognition of sepsis and treatments are needed to reduce its mortality. The use of citrullinated Histone H3 (Cit-H3) as an early sepsis marker and outcome predictor has been validated in previous studies among adults. However, only one study in pediatric meningococcal sepsis was reported with contradictory results. This study aims to determine Cit-H3 levels in pediatric clinical sepsis and analyze its association with sepsis severity and survival rate.METHODS: A prospective observational cohort study involving 67 pediatric subjects clinically diagnosed with sepsis was conducted. Cit-H3 levels, Pediatric Logistic Organ Dysfunction-2 (PELOD-2) score, and Pediatric Sequential Organ Failure Assessment (pSOFA) score were assessed at the time of diagnosis (0-hour) and 48 hours later. Pearson Correlation test was used to determine the correlation between Cit-H3 levels with PELOD-2 and pSOFA scores and receiver operating curve to find the cut-off of Cit-H3 levels on clinical sepsis patients.RESULTS: Among clinically sepsis patients, the median Cit-H3 level was 1,210 (800-32,160) ng/mL, with optimal cut-off point ≥1200 ng/mL (sensitivity 83.3% and specificity 75.7%) to discriminate sepsis. The median Cit-H3 levels at 0-hour were lower in survivor compared to non-survivor group (p=0.016). Cit-H3 level was able to predict mortality with optimal cut-off point ≥1,200 ng/mL, sensitivity 72.2% and specificity 57.1% (AUC of 69.2%; p=0.017). Using survival analysis, Cit-H3 was significantly associated with the mortality rate (p=0.023; hazard ratio of 3.45).CONCLUSION: Cit-H3 level could be potential to predict pediatric sepsis events and its outcome.KEYWORDS: citrullinated histone H3, neutrophil extracellular traps, pediatric sepsis, PELOD-2 score, pSOFA score, survival
Background Malaria is a major cause of morbidity and mortalityin children, especially in developing countries. Art emisinincombination therapy (ACT) has higher rates of parasite clearanceand inhibition of anti-malarial drugs resistance than non-ACT.Hence, we compared the efficacies of artesunate-amodiaquine(AS-AQ) versus artesunate-sulfadoxine pyrimethamine (AS-SP)combination therapies in children with uncomplicated falciparummalaria.Objective To compare the fever clearance time, parasite clearancetime, and length of hospital stay in uncomplicated falciparummalaria patients treated with AS-AQ and AS-SP.Methods We reviewed the medical records of children aged 1- 14years with uncomplicated falciparum malaria admitted to Prof.Dr. R. D. Kandou Hospital between January 2002 - June 2010.Treatment efficacy was evaluated by fever clearance time, parasiteclearan ce time, and length of hospital stay. The differencesof treatment efficacy between the two groups of therapy werean alyzed by independent T test.Results We identified 185 children with uncomplicatedfalciparum malaria, 104 cases were treated with AS-AQ whilethe other 81 received AS-SP. Parasite clearance time was shorterin AS-AQ group than in AS-SP group at 1.38 (SD 0.69) versus1.91 (SD 0.93) days, respectively (95%CI of differences 0.3 0 to0. 76, P<0.05) . The length of hospital stay was shorterin AS-AQgroup than in the AS-SP group, at 5.01 (SD 1.22) versus 6.04(SD 0.98) days, respectively (95%CI of differences 0. 71 to 1.35,P < 0.05). However, there was no statistically significant differencein fever clearance time between the groups.Conclusion AS-AQ combination therapy reduces parasiteclearance time and length of hospital stay compared to AS-SP46 • Paediatrlndones, Vol. 54, No. 1, January 2014combination therapy in children with uncomplicated falciparummalaria.
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