Diagnostic and prognostic value of procalcitonin and mid-regional pro-adrenomedullin in septic paediatric patients

Solé‐Ribalta, Anna; Pérez, Sandra Martínez; Valls, A.; Girona‐Alarcón, Mònica; Launes, Cristian; Cambra, Francisco José; Jordan, Iolanda; Esteban, Elisabeth

doi:10.1007/s00431-020-03587-7

Cited by 14 publications

(13 citation statements)

References 17 publications

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“…Furthermore, proADM also showed a good correlation with an increased need for inotropic support. This is consistent with the results of other studies, where proADM was higher in children with sepsis who required vasoactive drugs [35].…”

Section: Plos Onesupporting

confidence: 93%

Pro-atrial natriuretic peptide and pro-adrenomedullin before cardiac surgery in children. Can we predict the future?

Pérez¹,

Girona‐Alarcón²,

Corniero³

et al. 2020

PLoS ONE

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Introduction and objective Pro-atrial natriuretic peptide (proANP) and pro-adrenomedullin (proADM) levels increase in acute heart failure and sepsis. After cardiac surgery, children may require increased support in the intensive care unit and may develop complications. The aim of this study was to evaluate the utility of proANP and proADM values, determined prior to cardiac surgery, for predicting the need for increased respiratory or inotropic support during the post-operative period. Methods This was a prospective study in children. Biomarkers were analyzed before surgery using a single blood test. The primary endpoints were the need for greater respiratory and/or inotropic support during the post-operative period. Secondary endpoints were the relationship between these biomarkers and complications after surgery. Results One hundred thirteen patients were included. ProANP and proADM were higher in children who required greater respiratory and inotropic support, especially proANP; for increased respiratory support, 578.9 vs. 106.6 pmol/L (p = 0.004), and for increased inotropic support, 1938 vs. 110.4 pmol/L (p = 0.002). ProANP had a greater AUC than proADM for predicting increased respiratory support after surgery: 0.791 vs. 0.724. A possible cutoff point for proANP could be � 325 pmol/L (sensitivity = 66.7% and specificity = 88.8%). In the multivariate analysis, the logarithmic transformation of proANP was independently associated with the need for increased respiratory support (OR = 3.575). Patients who presented a poor

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Section: Plos Onesupporting

confidence: 93%

Pro-atrial natriuretic peptide and pro-adrenomedullin before cardiac surgery in children. Can we predict the future?

Pérez¹,

Girona‐Alarcón²,

Corniero³

et al. 2020

PLoS ONE

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“…MR-proADM levels were also significantly increased in patients requiring vasoactive drugs; however, unlike in the previous study, they were associated with renal dysfunction but not with the need for mechanical ventilation. It was concluded that PCT appears to be superior to MR-proADM in the diagnosis of sepsis, and that the determination of plasma MR-proADM levels in the early stages of sepsis could be a useful tool for its stratification and predicting morbidity [ 16 ].…”

Section: Resultsmentioning

confidence: 99%

A Review of Adrenomedullin in Pediatric Patients: A Useful Biomarker

2022

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Adrenomedullin has several properties. It acts as a potent vasodilator, has natriuretic effects, and reduces endothelial permeability. It also plays a role in initiating the early hyperdynamic phase of sepsis. Since its discovery, many articles have been published studying the uses and benefits of this biomarker. The aim of this review is to determine the usefulness of adrenomedullin in pediatric patients. Relevant studies covering adrenomedullin in pediatrics (<18 years) and published up until August 2021 were identified through a search of MEDLINE, PubMed, Embase, Web of Science, Scopus, and Cochrane. Seventy studies were included in the present review, most of them with a low level of evidence (IV to VI). Research on adrenomedullin has primarily been related to infection and the cardiovascular field. The performance of adrenomedullin to quantify infection in children seems satisfactory, especially in sepsis. In congenital heart disease, this biomarker seems to be a useful indicator before, during, and after cardiopulmonary bypass. Adrenomedullin seems to be useful in the pediatric population for a large variety of pathologies, especially regarding infection and cardiovascular conditions. However, it should be used in combination with other biomarkers and clinical or analytical variables, rather than as a single tool.

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“…Procalcitonin, already in widespread use as well, appears to be more specific for bacterial infections 29 . Recently, MR‐proADM has been described as an useful biomarker in the diagnosis and stratification of septic patients, helping to establish a prognosis in both adult and paediatric patients 30,31 . All these biomarkers have a good timing and cost‐performance index.…”

Section: Discussionmentioning

confidence: 99%

New multivariable prediction model PEdiatric SEpsis recognition and stratification (PESERS score) shows excellent discriminatory capacity

et al. 2022

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Aim To develop a quantitative predictive scoring model for the early recognition and assessment of paediatric sepsis. Methods Prospective observational study including emergency department and in‐hospital febrile patients under 18 years. Sepsis diagnose (Goldstein 2005 definitions) was the main outcome. Variables associated with the outcome were included in a multivariable analysis. Cut‐off points, odds ratio and coefficients for the variables kept after the multivariable analysis were identified. The score was obtained from the coefficients, The AUC was obtained from ROC‐analysis, and internal validation was performed using k‐fold cross‐validation. Results The analysis included 210 patients. 45 variables were evaluated and the bivariate analysis identified 24 variables associated with the outcome. After the multivariable regression, 11 variables were kept and the score was obtained. The model yielded an excellent AUC of 0.886 (95% CI 0.845–0.927), p < 0.001 for sepsis recognition. With a cut‐off value of 5 for the score, we obtained a sensitivity of 98%, specificity of 76.7%, positive predictive value of 87.9% and negative predictive value of 93.3%. Conclusion The proposed scoring model for paediatric sepsis showed adequate discriminatory capacity and sufficient accuracy, which is of great clinical significance in detecting sepsis early and predicting its severity. Nevertheless external validation is needed before clinical use.

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Diagnostic and prognostic value of procalcitonin and mid-regional pro-adrenomedullin in septic paediatric patients

Cited by 14 publications

References 17 publications

Pro-atrial natriuretic peptide and pro-adrenomedullin before cardiac surgery in children. Can we predict the future?

Pro-atrial natriuretic peptide and pro-adrenomedullin before cardiac surgery in children. Can we predict the future?

A Review of Adrenomedullin in Pediatric Patients: A Useful Biomarker

New multivariable prediction model PEdiatric SEpsis recognition and stratification (PESERS score) shows excellent discriminatory capacity

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