Department of Paediatric Infectious Diseases and Vaccines, University of Basel Children's Hospital, Basel, Switzerland.
Department of Paediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel, Switzerland.
PLoS One. 2022 Mar 10;17(3):e0264305. doi: 10.1371/journal.pone.0264305. eCollection 2022.
Kinetics of copeptin and mid regional proadrenomedullin (MR-proADM) during febrile pediatric lower respiratory tract infections (LRTI) are unknown. We aimed to analyze kinetic profiles of copeptin and MR-proADM and the impact of clinical and laboratory factors on those biomarkers.
This is a retrospective post-hoc analysis of a randomized controlled trial, evaluating procalcitonin guidance for antibiotic treatment of LRTI (ProPAED-study). In 175 pediatric patients presenting to the emergency department plasma copeptin and MR-proADM concentrations were determined on day 1, 3, and 5. Their association with clinical characteristics and other inflammatory biomarkers were tested by non-linear mixed effect modelling.
Median copeptin and MR-proADM values were elevated on day 1 and decreased during on day 3 and 5 (-26%; -34%, respectively). The initial concentrations of MR-proADM at inclusion were higher in patients receiving antibiotics intravenously compared to oral administration (difference 0.62 pmol/L, 95%CI 0.44;1.42, p<0.001). Intensive care unit (ICU) admission was associated with a daily increase of MR-proADM (increase/day 1.03 pmol/L, 95%CI 0.43;1.50, p<0.001). Positive blood culture in patients with antibiotic treatment and negative results on nasopharyngeal aspirates, or negative blood culture were associated with a decreasing MR-proADM (decrease/day -0.85 pmol/L, 95%CI -0.45;-1.44), p<0.001).
Elevated MR-proADM and increases thereof were associated with ICU admission suggesting the potential as a prognostic factor for severe pediatric LRTI. MR-proADM might only bear limited value for decision making on stopping antibiotics due to its slow decrease. Copeptin had no added value in our setting.
发热性儿科下呼吸道感染（LRTI）期间的 copeptin 和中区域 proadrenomedullin（MR-proADM）动力学尚不清楚。我们旨在分析 copeptin 和 MR-proADM 的动力学特征，以及临床和实验室因素对这些生物标志物的影响。
这是一项评估 LRTI 中降钙素原指导抗生素治疗的随机对照试验（ProPAED 研究）的回顾性事后分析。在 175 名因 LRTI 就诊于急诊科的儿科患者中，在第 1、3 和 5 天测定血浆 copeptin 和 MR-proADM 浓度。通过非线性混合效应模型测试它们与临床特征和其他炎症生物标志物的相关性。
第 1 天 copeptin 和 MR-proADM 的中位数升高，第 3 天和第 5 天降低（分别降低 26%和 34%）。纳入时静脉内给予抗生素的患者初始 MR-proADM 浓度高于口服给药（差异 0.62 pmol/L，95%CI 0.44；1.42，p<0.001）。入住重症监护病房（ICU）与 MR-proADM 每日增加相关（增加量 1.03 pmol/L，95%CI 0.43；1.50，p<0.001）。接受抗生素治疗且鼻咽抽吸物结果为阳性或血培养为阴性的患者中，血培养阳性与 MR-proADM 下降相关（下降量 0.85 pmol/L，95%CI -0.45；-1.44，p<0.001）。
升高的 MR-proADM 及其增加与 ICU 入院相关，提示其作为严重儿科 LRTI 预后因素的潜力。由于 MR-proADM 下降缓慢，其对停止抗生素治疗的决策可能仅具有有限的价值。在我们的研究环境中，copeptin 没有附加价值。
