与生前确定住院儿童死亡原因相比，微创组织采样的贡献：马拉维微创组织采样研究

The contribution of minimally invasive tissue sampling compared to antemortem-derived cause of death determination among inpatient child deaths: the minimally invasive tissue sampling in Malawi study.

作者信息

Voskuijl Wieger P, Chasweka Dennis, Lawrence Sarah, Brals Daniella, Kamiza Steve, Bandsma Robert, Berkley James A, Mbale Emmie, Attipa Charalampos, Eneya Chisomo, Huwa Cornelius, Khoswe Stanley, Moxon Christopher, Potani Isabel, Waller Jessica L, Diaz Maureen H, Walson Judd, Ordi Jaume, Denno Donna M

机构信息

Amsterdam UMC, University of Amsterdam, Amsterdam Centre for Global Child Health, Emma Children's Hospital, Amsterdam, the Netherlands.

Amsterdam UMC, University of Amsterdam, Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands.

出版信息

J Glob Health. 2025 Aug 4;15:04210. doi: 10.7189/jogh.15.04210.

DOI:10.7189/jogh.15.04210

PMID:40755013

Abstract

BACKGROUND

Improved causes of death (CoD) understanding in low- and middle-income countries is needed to reduce child mortality. Compared to full autopsy, minimally invasive tissue sampling (MITS), using transcutaneous needle sampling, is a feasible, socially acceptable, and validated method. We aimed to quantify the additional contribution of MITS to CoD attribution based on clinical records and inpatient research data with intensive patient characterisation.

METHODS

We enrolled children aged seven days to 59 months who died while on admission for acute illness and/or severe malnutrition to Queen Elizabeth Central Hospital in Blantyre, Malawi. Standard MITS procedures included histologic, immunohistochemical, and microbiologic testing. Phase 1 CoD determination was based on medical records alone, Phase 2 also included research data, and Phase 3 included all data, including from MITS.

RESULTS

We enrolled 29 children. Based on clinical notes alone (Phase 1), we identified 60 causal and 39 contributing conditions. Of the 45 (45%) infectious conditions, pathogens were identified in 15 (33%). Only one patient's (3%) CoD was unchanged compared to including all data (Phase 3). Further, we identified 69 new (n = 43) or adjusted (n = 26) diagnoses among 28 cases (97%); the majority were undernutrition-related (n = 22, 32%) or infectious (n = 41, 59%) conditions. Overall, the majority of final Phase 3 conditions were also undernutrition-related (n = 46, 32%) or infectious (n = 61, 43%) and a pathogen was identified in 54 (89%) of the infectious conditions. Klebsiella pneumoniae was the most prevalent aetiology in both pneumonia and sepsis.

CONCLUSIONS

The addition of MITS to clinical and inpatient research data led to almost all (97%) of cases receiving new and/or refined diagnoses, including microbe identification in infectious conditions. Pathogens not specifically addressed by current clinical guidelines, such as Klebisiella pneumoniae, were commonly identified. Our findings support the utility of MITS to understand CoD even after thorough clinical characterisation of children during hospitalisation.

摘要

背景

为降低儿童死亡率，低收入和中等收入国家需要更好地了解死因。与完整尸检相比，使用经皮穿刺采样的微创组织采样（MITS）是一种可行、社会可接受且经过验证的方法。我们旨在根据临床记录和具有详细患者特征的住院研究数据，量化MITS对死因归因的额外贡献。

方法

我们纳入了在马拉维布兰太尔伊丽莎白女王中央医院因急性疾病和/或严重营养不良入院期间死亡的7天至59个月大的儿童。标准的MITS程序包括组织学、免疫组织化学和微生物学检测。第1阶段的死因确定仅基于医疗记录，第2阶段还包括研究数据，第3阶段包括所有数据，包括来自MITS的数据。

结果

我们纳入了29名儿童。仅根据临床记录（第1阶段），我们确定了60种因果关系和39种促成因素。在45种（45%）感染性疾病中，15种（33%）鉴定出了病原体。与纳入所有数据（第3阶段）相比，只有一名患者（3%）的死因未变。此外，我们在28例（97%）病例中确定了69项新的（n = 43）或调整后的（n = 26）诊断；大多数与营养不良相关（n = 22，32%）或感染性疾病（n = 41，59%）。总体而言，第3阶段最终的大多数情况也与营养不良相关（n = 46，32%）或感染性疾病（n = 61，43%），并且在54种（89%）感染性疾病中鉴定出了病原体。肺炎克雷伯菌是肺炎和败血症中最常见的病因。