Urinary L-FABP as a mortality predictor in <5-year-old children with sepsis in Bangladesh

BackgroundAlthough 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. MethodsThis 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). ResultsOn 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-FABP370 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). ConclusionUrinary L-FABP may be a useful predictor of mortality in septic children. Urinary examination is non-invasive and easy to apply at the bedside.