Project description:Children with complicated severe malnutrition (CSM) face high mortality after hospital discharge, yet the underlying mechanisms remain poorly understood. While early post-discharge mortality (<2 months) has been linked to a sepsis-like inflammatory profile at discharge, it is unclear whether this persists and contributes to late post-discharge mortality (LPDM; 2 to 6 months post-discharge). This study investigated whether immune, inflammatory, and endothelial dysfunction at 2 months post-discharge are associated with LPDM in children recovering from CSM. We conducted a case-control study nested within a randomized placebo-controlled trial of daily co-trimoxazole in HIV-negative children aged 2 to 59 months with CSM in four Kenyan hospitals. Cases were children who died between 2 and 6 months post-discharge; controls were survivors frequency-matched by sex, site, and trial arm. We used untargeted Tandem Mass Tagging based proteomics to quantify components of the plasma protein expression profiles associated with LPDM of children with CSM.