Alcoba Gabriel, Manzano Sergio, Lacroix Laurence, Galetto-Lacour Annick, Gervaix Alain
Pediatric Emergency Division, Geneva University Hospitals (HUG), Rue Gabrielle Perret-Gentil 6, 1211, Geneva 14, Switzerland.
Tropical & Humanitarian Medicine Division, Geneva University Hospitals (HUG), Rue Gabrielle Perret-Gentil 6, 1211, Geneva 14, Switzerland.
BMC Infect Dis. 2015 Aug 19;15:347. doi: 10.1186/s12879-015-1095-5.
Community-acquired-pneumonia is the leading cause of child mortality worldwide. Very few studies have explored the predictive value of Proadrenomedullin and Copeptin in pediatric severe pneumonia and bacteremia.
Proadrenomedullin and Copeptin were assessed as predictors for complicated community-acquired pneumonia (bacteremia, empyema) in 88 children aged 0 to 16 years presenting to the pediatric emergency department, using B.R.A.H.M.S. Kryptor Compact pro-ADM and Copeptin with the TRACE technology (time-resolved amplified cryptase emission). STARD standard reporting was used.
A complicated community-acquired pneumonia was found in 11 out of 88 children (12.5 %). Proadrenomedullin median values increased more than twofold, in complicated vs. uncomplicated (0.18 vs. 0.08 nmol/L, p = 0.039), and fivefold in bacteremic vs. non-bacteremic pneumonia (0.40 vs. 0.08 nmol/L, p = 0.02). Proadrenomedullin > 0.16 nmol/L showed 100 % sensitivity (95 % CI 39.8 - 100.0) and 70 % (95 % CI 58.7 - 79.7) specificity for bacteremia. Copeptin showed no added-value.
Proadrenomedullin seems a reliable and available predictor for complicated CAP, and could therefore help the physician with the decision to hospitalize, and choose the antibiotics administration route. Larger studies are needed.
社区获得性肺炎是全球儿童死亡的主要原因。很少有研究探讨前肾上腺髓质素和 copeptin 在小儿重症肺炎和菌血症中的预测价值。
对 88 名年龄在 0 至 16 岁、前往儿科急诊科就诊的儿童，使用 B.R.A.H.M.S. Kryptor Compact pro-ADM 和带有 TRACE 技术（时间分辨放大隐酶发射）的 copeptin，评估前肾上腺髓质素和 copeptin 作为复杂性社区获得性肺炎（菌血症、脓胸）预测指标的情况。采用 STARD 标准报告。
88 名儿童中有 11 名（12.5%）患有复杂性社区获得性肺炎。与非复杂性肺炎相比，复杂性肺炎患者前肾上腺髓质素的中位数增加了两倍多（分别为 0.18 vs. 0.08 nmol/L，p = 0.039），菌血症性肺炎与非菌血症性肺炎相比增加了五倍（分别为 0.40 vs. 0.08 nmol/L，p = 0.02）。前肾上腺髓质素>0.16 nmol/L 对菌血症的敏感性为 100%（95%CI 39.8 - 100.0），特异性为 70%（95%CI 58.7 - 79.7）。copeptin 未显示出附加价值。
前肾上腺髓质素似乎是复杂性社区获得性肺炎的可靠且可用的预测指标，因此可帮助医生做出住院决策，并选择抗生素给药途径。需要进行更大规模的研究。
