Acute kidney injury in Ugandan children with severe malaria is associated with long-term behavioral problems

English version

Autoři: Meredith R. Hickson ^aff001; Andrea L. Conroy ^aff002; Paul Bangirana ^aff003; Robert O. Opoka ^aff004; Richard Idro ^aff004; John M. Ssenkusu ^aff006; Chandy C. John ^aff002
Působiště autorů: Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America ^aff001; Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indiana, United States of America ^aff002; Department of Psychiatry, Makerere University of School of Medicine, Kampala, Uganda ^aff003; Department of Paediatrics and Child Health, Makerere University School of Medicine, Kampala, Uganda ^aff004; Centre of Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom ^aff005; Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda ^aff006
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0226405

Souhrn

Background

Acute kidney injury (AKI) is a risk factor for neurocognitive impairment in severe malaria (SM), but the impact of AKI on long-term behavioral outcomes following SM is unknown.

Methods

We conducted a prospective study on behavioral outcomes of Ugandan children 1.5 to 12 years of age with two forms of severe malaria, cerebral malaria (CM, n = 226) or severe malarial anemia (SMA, n = 214), and healthy community children (CC, n = 173). AKI was defined as a 50% increase in creatinine from estimated baseline. Behavior and executive function were assessed at baseline and 6, 12, and 24 months later using the Child Behavior Checklist and Behavior Rating Inventory of Executive Function, respectively. Age-adjusted z-scores were computed for each domain based on CC scores. The association between AKI and behavioral outcomes was evaluated across all time points using linear mixed effect models, adjusting for sociodemographic variables and disease severity.

Results

AKI was present in 33.2% of children with CM or SMA at baseline. Children ≥6 years of age with CM or SMA who had AKI on admission had worse scores in socio-emotional function in externalizing behaviors (Beta (95% CI), 0.52 (0.20, 0.85), p = 0.001), global executive function (0.48 (0.15, 0.82), p = 0.005) and behavioral regulation (0.66 (0.32, 1.01), p = 0.0002) than children without AKI. There were no behavioral differences associated with AKI in children <6 years of age.

Conclusions

AKI is associated with long-term behavioral problems in children ≥6 years of age with CM or SMA, irrespective of age at study enrollment.

Klíčová slova:

Cognitive impairment – Behavior – Children – Malaria – Kidneys – Creatinine – Cerebral malaria – Metacognition

Zdroje

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