Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, and Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Sections of Emergency Medicine and Hospital Medicine, Children's Hospital Colorado, Department of Pediatrics, University of Colorado, Aurora, Colorado, USA.
Clin Infect Dis. 2021 Aug 2;73(3):e524-e530. doi: 10.1093/cid/ciaa1138.
Proadrenomedullin (proADM), a vasodilatory peptide with antimicrobial and anti-inflammatory properties, predicts severe outcomes in adults with community-acquired pneumonia (CAP) to a greater degree than C-reactive protein and procalcitonin. We evaluated the ability of proADM to predict disease severity across a range of clinical outcomes in children with suspected CAP.
We performed a prospective cohort study of children 3 months to 18 years with CAP in the emergency department. Disease severity was defined as mild (discharged home), mild-moderate (hospitalized but not moderate-severe or severe), moderate-severe (eg, hospitalized with supplemental oxygen, broadening of antibiotics, complicated pneumonia), and severe (eg, vasoactive infusions, chest drainage, severe sepsis). Outcomes were examined using proportional odds logistic regression within the cohort with suspected CAP and in a subset with radiographic CAP.
Among 369 children, median proADM increased with disease severity (mild: median [IQR], 0.53 [0.43-0.73]; mild-moderate: 0.56 [0.45-0.71]; moderate-severe: 0.61 [0.47-0.77]; severe: 0.70 [0.55-1.04] nmol/L) (P = .002). ProADM was significantly associated with increased odds of developing severe outcomes (suspected CAP: OR, 1.68; 95% CI, 1.2-2.36; radiographic CAP: OR, 2.11; 95% CI, 1.36-3.38) adjusted for age, fever duration, antibiotic use, and pathogen. ProADM had an AUC of 0.64 (95% CI, .56-.72) in those with suspected CAP and an AUC of 0.77 (95% CI, .68-.87) in radiographic CAP.
ProADM was associated with severe disease and discriminated moderately well children who developed severe disease from those who did not, particularly in radiographic CAP.
前肾上腺髓质素（proADM）是一种具有血管扩张、抗微生物和抗炎特性的肽，与 C 反应蛋白和降钙素原相比，其在预测成人社区获得性肺炎（CAP）的严重结局方面具有更大的优势。我们评估了 proADM 预测儿童疑似 CAP 患者一系列临床结局严重程度的能力。
我们对急诊科患有 CAP 的 3 个月至 18 岁儿童进行了前瞻性队列研究。疾病严重程度定义为轻度（出院回家）、轻度-中度（住院但非中度-重度或重度）、中度-重度（例如，住院需要补充氧气、抗生素扩大使用、合并肺炎）和重度（例如，血管活性药物输注、胸腔引流、严重败血症）。使用比例优势逻辑回归在疑似 CAP 队列和放射学 CAP 亚组中检查了结局。
在 369 名儿童中，随着疾病严重程度的增加，中位数 proADM 升高（轻度：中位数 [IQR]，0.53 [0.43-0.73]；轻度-中度：0.56 [0.45-0.71]；中度-重度：0.61 [0.47-0.77]；重度：0.70 [0.55-1.04] nmol/L）（P=0.002）。ProADM 与发生严重结局的几率增加显著相关（疑似 CAP：比值比，1.68；95%置信区间，1.2-2.36；放射学 CAP：比值比，2.11；95%置信区间，1.36-3.38），调整了年龄、发热持续时间、抗生素使用和病原体。在疑似 CAP 患者中，ProADM 的 AUC 为 0.64（95%置信区间，0.56-0.72），在放射学 CAP 中 AUC 为 0.77（95%置信区间，0.68-0.87）。
ProADM 与严重疾病相关，并能较好地区分出发生严重疾病和未发生严重疾病的儿童，特别是在放射学 CAP 中。
