tetano
Editor, Senior Moderator
Open Forum Infect Dis
. 2020 Apr 9;7(5)
faa122.
doi: 10.1093/ofid/ofaa122. eCollection 2020 May.
Early Amplified Respiratory Bioactive Lipid Response Is Associated With Worse Outcomes in Pediatric Influenza-Related Respiratory Failure
Veronica G Anania[SUP] 1 [/SUP], Adrienne G Randolph[SUP] 2 3 [/SUP], Xiaoying Yang[SUP] 4 [/SUP], Allen Nguyen[SUP] 1 [/SUP], Margaret M Newhams[SUP] 2 [/SUP], W Rodney Mathews[SUP] 1 [/SUP], Carrie M Rosenberger[SUP] 5 [/SUP], Jacqueline M McBride[SUP] 1 [/SUP]
Affiliations
Abstract
Background: Biomarkers are needed for early identification of patients at risk of severe complications from influenza infection, including prolonged respiratory failure and death. Eicosanoids are bioactive lipid mediators with pro- and anti-inflammatory properties produced in response to infection. This study assessed the relationships between the host bioactive lipid response, influenza viral load, and clinical outcomes.
Methods: Influenza-positive, intubated children ≤18 years old were enrolled across 26 US pediatric intensive care units (PICUs). Mass spectrometry was used to measure >100 lipid metabolites in endotracheal and nasopharyngeal samples. Influenza viral load was measured by quantitative polymerase chain reaction.
Results: Age and bacterial co-infection were associated with multiple bioactive lipids (P < .05). Influenza viral load was lower in patients with bacterial co-infection compared with those without, and pro-inflammatory bioactive lipids positively correlated with viral load in bacterially co-infected children (P < .05). Lipids associated with disease resolution correlated with viral load in patients without bacterial co-infection (P < .01). After adjusting for age and bacterial co-infection status, elevated pro- and anti-inflammatory lipids measured early in the intensive care unit course were associated with higher mortality, whereas influenza viral load and endotracheal cytokine levels were not associated with clinical outcomes. Prostaglandin E[SUB]2[/SUB], arachidonic acid, docosahexaenoic acid, and 12-hydroxyeicosatetraenoic acid measured within 72 hours of PICU admission predicted death or prolonged (≥28 days) mechanical ventilator support (area under the curve, 0.72-0.79; P < .02) not explained by admission illness severity.
Conclusions: Children with influenza-related complications have early bioactive lipid responses that may reflect lung disease severity. Respiratory bioactive lipids are candidate prognostic biomarkers to identify children with the most severe clinical outcomes.
Keywords: bacterial infection; influenza; lipids; mass spectrometry; pediatric care.
. 2020 Apr 9;7(5)
faa122.doi: 10.1093/ofid/ofaa122. eCollection 2020 May.
Early Amplified Respiratory Bioactive Lipid Response Is Associated With Worse Outcomes in Pediatric Influenza-Related Respiratory Failure
Veronica G Anania[SUP] 1 [/SUP], Adrienne G Randolph[SUP] 2 3 [/SUP], Xiaoying Yang[SUP] 4 [/SUP], Allen Nguyen[SUP] 1 [/SUP], Margaret M Newhams[SUP] 2 [/SUP], W Rodney Mathews[SUP] 1 [/SUP], Carrie M Rosenberger[SUP] 5 [/SUP], Jacqueline M McBride[SUP] 1 [/SUP]
Affiliations
- PMID: 32420403
- PMCID: PMC7216777
- DOI: 10.1093/ofid/ofaa122
Abstract
Background: Biomarkers are needed for early identification of patients at risk of severe complications from influenza infection, including prolonged respiratory failure and death. Eicosanoids are bioactive lipid mediators with pro- and anti-inflammatory properties produced in response to infection. This study assessed the relationships between the host bioactive lipid response, influenza viral load, and clinical outcomes.
Methods: Influenza-positive, intubated children ≤18 years old were enrolled across 26 US pediatric intensive care units (PICUs). Mass spectrometry was used to measure >100 lipid metabolites in endotracheal and nasopharyngeal samples. Influenza viral load was measured by quantitative polymerase chain reaction.
Results: Age and bacterial co-infection were associated with multiple bioactive lipids (P < .05). Influenza viral load was lower in patients with bacterial co-infection compared with those without, and pro-inflammatory bioactive lipids positively correlated with viral load in bacterially co-infected children (P < .05). Lipids associated with disease resolution correlated with viral load in patients without bacterial co-infection (P < .01). After adjusting for age and bacterial co-infection status, elevated pro- and anti-inflammatory lipids measured early in the intensive care unit course were associated with higher mortality, whereas influenza viral load and endotracheal cytokine levels were not associated with clinical outcomes. Prostaglandin E[SUB]2[/SUB], arachidonic acid, docosahexaenoic acid, and 12-hydroxyeicosatetraenoic acid measured within 72 hours of PICU admission predicted death or prolonged (≥28 days) mechanical ventilator support (area under the curve, 0.72-0.79; P < .02) not explained by admission illness severity.
Conclusions: Children with influenza-related complications have early bioactive lipid responses that may reflect lung disease severity. Respiratory bioactive lipids are candidate prognostic biomarkers to identify children with the most severe clinical outcomes.
Keywords: bacterial infection; influenza; lipids; mass spectrometry; pediatric care.