Enteric permeability, systemic inflammation and post-discharge growth among a cohort of hospitalized children in Kenya and Pakistan.
Tickell KD., Denno DM., Saleem A., Ali A., Kazi Z., Singa BO., Otieno C., Mutinda C., Ochuodho V., Richardson BA., Ásbjörnsdóttir KH., Hawes SE., Berkley JA., Walson JL.
ObjectivesTo determine whether gut permeability is associated with post-discharge growth and systemic inflammation among hospitalized children in low- and middle-income countries.MethodsChildren aged 2-23 months being discharged from Civil Hospital Karachi (Pakistan) and Migori County Referral Hospital (Kenya) underwent lactulose rhamnose ratio (LRR) permeability testing and were compared to age-matched children from their home communities. Linear mixed effect models estimated the associations between LRR among discharged children with change in length-for-age (LAZ) and weight-for-age z-score (WAZ) at 45, 90 and 180 days after discharge. Linear regression tested if relationships between LRR, systemic inflammation (CRP, CD14, TNFα, IL-6) and enterocyte damage (I-FABP) differed between the hospitalized and community groups.Results137 hospitalized and 84 community participants were included. The hospitalized group had higher log-LRR (0.43, 95%CI: 0.15, 0.71, p=0.003) than the community children. Adjustment for weight-for-length z-score at discharge attenuated this association (0.31, 95%CI: 0.00, 0.62, p=0.049). LRR was not associated with changes in WAZ or LAZ in the post-discharge period. Associations between LRR and CRP (interaction p=0.036), TNFα (p=0.017), CD14 (p=0.078) and IL-6 (p=0.243) differed between community and hospitalized groups. LRR was associated with TNFα (p=0.004) and approached significance with CD14 (p=0.078) and IL-6 (p=0.062) in community children, but there was no evidence of these associations among hospitalized children.ConclusionsAlthough increased enteric permeability is more prevalent among children being discharged from hospital compared to children in the community, it does not appear to be an important determinant of systemic inflammation or post-discharge growth among hospitalized children.