From the Division of Emergency Medicine, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Department of Pediatrics, Sections of Emergency Medicine and Hospital Medicine, Children's Hospital Colorado, University of Colorado, Aurora, Colorado.
Pediatr Infect Dis J. 2021 Dec 1;40(12):1070-1075. doi: 10.1097/INF.0000000000003336.
Plasma proadrenomedullin (proADM) is a promising biomarker to predict disease severity in community-acquired pneumonia (CAP). Urinary biomarkers offer advantages over blood, including ease of collection. We evaluated the association between urinary proADM and disease severity in pediatric CAP.
We performed a prospective cohort study of children 3 months to 18 years with CAP. Urinary proADM/creatinine (Cr) was calculated. Disease severity was defined as: mild (discharged home), mild-moderate (hospitalized but not moderate-severe or severe), moderate-severe (eg, hospitalized with supplemental oxygen and complicated pneumonia) and severe (eg, vasopressors and invasive ventilation). Outcomes were examined using logistic regression within the cohort with suspected CAP and in a subset with radiographic CAP.
Of the 427 children included, higher proADM/Cr was associated with increased odds of severe disease compared with nonsevere disease [suspected CAP, odds ratio (OR) 1.02 (95% confidence interval (CI) 1.003, 1.04); radiographic CAP, OR 1.03 (95% CI 1.01, 1.06)] when adjusted for other covariates. ProADM/Cr had an area under the receiver operating characteristic curve of 0.56 (threshold 0.9 pmol/mg) to differentiate severe from nonsevere disease in suspected CAP and 0.65 in radiographic CAP (threshold 0.82 pmol/mg). Healthy controls had less proADM in their urine (median, 0.61 pmol/mg) compared with suspected (0.87 pmol/mg, P = 0.018) and radiographic (0.73 pmol/mg, P = 0.016) CAP.
Urinary proADM/Cr ratio measured at the time of emergency department visit was statistically associated with the development of severe outcomes in children with CAP, with stronger discriminatory performance in radiographic disease.
血浆前肾上腺髓质素（proADM）是预测社区获得性肺炎（CAP）疾病严重程度的有前途的生物标志物。尿生物标志物比血液具有优势，包括易于采集。我们评估了儿科 CAP 患者尿 proADM 与疾病严重程度之间的关系。
我们对 3 个月至 18 岁的 CAP 患儿进行了前瞻性队列研究。计算尿 proADM/肌酐（Cr）比值。疾病严重程度定义为：轻度（出院回家）、轻度中度（住院但非中重度或重度）、中重度（例如，住院需要补充氧气和并发肺炎）和重度（例如，血管加压素和有创通气）。使用队列中的逻辑回归和具有放射学 CAP 的亚组检查结果。
在 427 名患儿中，与非严重疾病相比，较高的 proADM/Cr 与严重疾病的发生几率增加相关[疑似 CAP，比值比（OR）1.02（95%置信区间（CI）1.003，1.04）；放射学 CAP，OR 1.03（95% CI 1.01，1.06）]，当调整其他协变量时。proADM/Cr 在疑似 CAP 中区分严重和非严重疾病的受试者工作特征曲线下面积为 0.56（阈值 0.9 pmol/mg），在放射学 CAP 中为 0.65（阈值 0.82 pmol/mg）。与疑似 CAP（0.87 pmol/mg，P=0.018）和放射学 CAP（0.73 pmol/mg，P=0.016）相比，健康对照组患儿尿液中的 proADM 含量较低（中位数，0.61 pmol/mg）。
在急诊科就诊时测量的尿 proADM/Cr 比值与 CAP 患儿严重结局的发生具有统计学相关性，在放射学疾病中具有更强的鉴别性能。
