印度南部三级护理医院中脓毒症新生儿前肾上腺髓质素的诊断和预后有效性
Diagnostic and Prognostic Validity of Proadrenomedullin among Neonates with Sepsis in Tertiary Care Hospitals of Southern India.
作者信息
Kannan Raja, Rao Suchetha S, Mithra Prasanna, Dhanashree B, Baliga Shantharam, Bhat Kamalakshi G
机构信息
Senior Resident, Department of Pediatrics, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Mangalore, Karnataka 575001, India.
Associate Professor, Department of Pediatrics, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Mangalore, Karnataka 575001, India.
出版信息
Int J Pediatr. 2018 Aug 1;2018:7908148. doi: 10.1155/2018/7908148. eCollection 2018.
INTRODUCTION
To evaluate Proadrenomedullin (Pro-ADM) as the diagnostic and prognostic marker in neonatal sepsis.
MATERIALS AND METHODS
In this cross-sectional study, Pro-ADM levels were estimated in 54 neonates with clinical sepsis and positive sepsis screen (cases) and 54 controls without clinical sepsis. Repeat Pro-ADM levels were estimated after 72 hours in cases. Pro-ADM levels were compared with the clinical outcome.
RESULTS AND DISCUSSION
Median Pro-ADM levels in cases were 31.8 (IQR: 27.8-39.4) pmol/ml which was significantly higher than controls 5.1 (IQR; 3.1-7.7) pmol/ml. From the constructed ROC curve, a value of 14.5 pmol/ml was taken as the cut-off for sepsis. Pro-ADM had 100% sensitivity, specificity, and positive predictive values (PPV) in detecting sepsis at 14.5 pmol/ml. Among cases, a decrease in Pro-ADM level by 10 pmol/ml was associated with 99% survival. Pro-ADM value of 35 pmol/ml had 100% specificity and PPV in predicting mortality.
CONCLUSION
Pro-ADM can be used as a single biomarker for detecting neonatal sepsis, predicting clinical outcome and prognosis.
引言
评估前肾上腺髓质素（Pro-ADM）作为新生儿败血症的诊断和预后标志物。
材料与方法
在这项横断面研究中，对54例临床败血症且败血症筛查呈阳性的新生儿（病例组）和54例无临床败血症的对照进行了Pro-ADM水平评估。病例组在72小时后重复评估Pro-ADM水平。将Pro-ADM水平与临床结局进行比较。
结果与讨论
病例组Pro-ADM水平中位数为31.8（四分位间距：27.8 - 39.4）pmol/ml，显著高于对照组的5.1（四分位间距：3.1 - 7.7）pmol/ml。根据构建的ROC曲线，将14.5 pmol/ml作为败血症的临界值。Pro-ADM在14.5 pmol/ml时检测败血症的灵敏度、特异度和阳性预测值（PPV）均为100%。在病例组中，Pro-ADM水平降低10 pmol/ml与99%的生存率相关。Pro-ADM值为35 pmol/ml时预测死亡率的特异度和PPV均为100%。
结论
Pro-ADM可作为检测新生儿败血症、预测临床结局和预后的单一生物标志物。
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