Paediatric Intensive Care Unit Service, Hospital Sant Joan de Déu, University of Barcelona, Passeig de Sant Joan de Déu number 2, 08950, Barcelona, Esplugues de Llobregat, Spain.
Immunological and Respiratory Disorders in the Paediatric Critical Patient Research Group, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Barcelona, Spain.
Eur J Pediatr. 2020 Jul;179(7):1089-1096. doi: 10.1007/s00431-020-03587-7. Epub 2020 Jan 23.
Early diagnosis of sepsis and its severity stratification at admission is critical to improve patient outcomes and to ensure the optimal use of health care resources. In order to assess the diagnostic potential of mid-regional pro-adrenomedullin (MR-proADM) in septic paediatric patients in comparison with procalcitonin (PCT), and to evaluate the usefulness of a single early determination of MR-proADM as a stratification and severity prediction tool, a prospective observational study was conducted. Seventy-three paediatric patients with a suspicion of sepsis were included. A single blood test was carried out at initial time to analyse infection biomarkers. PCT values were significantly higher in septic patients in comparison with non-septic patients (p = 0.03) with an AUC of 0.748 (p = 0.003). Levels of MR-proADM significantly increased in patients with severe sepsis (p = 0.048), with an AUC of 0.729 (p = 0.013). MR-proADM showed a positive correlation with pSOFA, PRISM III, and PELOD-2 severity scores. Levels of MR-proADM were significantly higher in patients who required vasoactive drugs (p = 0.02) or presented renal dysfunction (p = 0.004).Conclusion: PCT appeared to be superior to MR-proADM in diagnosing sepsis. Determining MR-proADM plasma levels at the initial phase of sepsis could be a useful tool for sepsis stratification and morbidity prediction before organ failure occurs. The present results need to be assessed with larger sample size studies.What is Known:•CRP and PCT are already included in clinical practice to assess sepsis and estimate disease severity, although their sensitivity and specificity are lower than desired.•ADM is a protein that has immune and vascular modulation actions, and its blood levels are increased in adult and paediatric sepsis.•ADM is a promising tool for early diagnosis and prognostic assessment in adult sepsis.What is New:•PCT appeared to be superior to MR-proADM in diagnosing paediatric sepsis.•MR-proADM plasma levels could be a useful tool for paediatric sepsis stratification and morbidity prediction.
早期诊断脓毒症及其入院严重程度分层对改善患者预后和确保医疗资源的最佳利用至关重要。为了评估中区域前肾上腺髓质素（MR-proADM）在脓毒症儿科患者中的诊断潜力与降钙素原（PCT）相比，并评估单次早期测定 MR-proADM 作为分层和严重程度预测工具的有用性，进行了一项前瞻性观察研究。共纳入 73 例疑似脓毒症的儿科患者。在初始时间进行单次血液检测以分析感染生物标志物。与非脓毒症患者相比，脓毒症患者的 PCT 值显着升高（p = 0.03），AUC 为 0.748（p = 0.003）。严重脓毒症患者的 MR-proADM 水平显着升高（p = 0.048），AUC 为 0.729（p = 0.013）。MR-proADM 与 pSOFA、PRISM III 和 PELOD-2 严重程度评分呈正相关。需要血管活性药物（p = 0.02）或存在肾功能障碍的患者（p = 0.004）的 MR-proADM 水平显着升高。结论：PCT 在诊断脓毒症方面似乎优于 MR-proADM。在发生器官衰竭之前，确定脓毒症初始阶段的 MR-proADM 血浆水平可能是一种有用的分层和发病率预测工具。需要更大样本量的研究来评估目前的结果。已知：•CRP 和 PCT 已经包含在临床实践中，用于评估脓毒症并估计疾病严重程度，尽管它们的敏感性和特异性不如预期。•ADM 是一种具有免疫和血管调节作用的蛋白质，其血液水平在成人和儿科脓毒症中增加。•ADM 是早期诊断和成人脓毒症预后评估的有前途的工具。新内容：•PCT 在诊断儿科脓毒症方面似乎优于 MR-proADM。•MR-proADM 血浆水平可能是儿科脓毒症分层和发病率预测的有用工具。
