Pro-adrenomedullin, pro-endothelin-1, procalcitonin, C-reactive protein and mortality risk in critically ill children: a prospective study

Abstract

IntroductionWe tested the hypothesis that higher mid-regional pro-adrenomedullin (MR-proADM), carboxy-terminal pro-endothelin-1 (CT-proET-1), procalcitonin (PCT) and C-reactive protein (CRP) plasma concentrations would be associated with increased prediction of mortality risk scores.MethodsProspective observational study set in two pediatric intensive care units (PICUs). Two-hundred-thirty-eight patients were included. MR-proADM, CT-proET-1, PCT and CRP levels were compared between children with PRISM III and PIM 2 > p75 (Group A; n = 33) and the rest (Group B; n = 205).ResultsMedian (range) MR-proADM levels were 1.39 nmol/L (0.52–12.67) in group A versus 0.54 (0.15–3.85) in group B (P < 0.001). CT-proET-1 levels were 172 pmol/L (27–500) versus 58 (4–447) (P < 0.001). PCT levels were 7.77 ng/mL (0.34–552.00) versus 0.28 (0.02–107.00) (P < 0.001). CRP levels were 6.23 mg/dL (0.08-28.25) versus 1.30 mg/dL (0.00-42.09) (P = 0.210). The area under the ROC curve (AUC) for the differentiation of group A and B was 0.87 (95% CI:0.81–0.821) for MR-proADM, 0.86 (95% CI:0.79–0.92) for CT-proET-1 and 0.84 (95% CI:0.74–0.94) for PCT. A MR-proADM > 0.79 nmol/L had 93% sensitivity and 76% specificity to differentiate groups, whereas a CT-proET-1 > 123 pmol/L had 77% sensitivity and 84% specificity, and a PCT concentration > 2.05 ng/mL had 80% sensitivity and specificity.ConclusionsIn critically ill children, high levels of MR-proADM, CT-proET-1 and PCT were associated with increased prediction of mortality risk scores. MR-proADM, CT-proET-1 and PCT concentrations higher than 0.80 nmol/L, 123 pmol/L and 2 ng/mL, respectively, could be used by clinicians to identify critically ill children at higher prediction of risk death scores.

Effects of probiotics combined with early enteral nutrition on endothelin-1 and C-reactive protein levels and prognosis in patients with severe traumatic brain injury

“…Su et al 19 also showed that elevated CRP protein levels might be a prognostic predictor in patients with mild TBI. Rey et al 20 recently found that Table 3. GCS, SOFA, and APACHE II scores in patients according to nutritional support.…”

Asociación de valores elevados de péptido natriurético auricular y copeptina con riesgo de mortalidad

“…Algunos biomarcadores podrían ayudar a estratificar a los niños críticamente enfermos en función de su riesgo de mortalidad 1,8 . En nuestro estudio, en una muestra heterogénea de niños gravemente enfermos, los niveles elevados de RM-proPNA, copeptina y PCT se asociaron a una mayor puntuación en las escalas de riesgo de mortalidad, así como a un mayor número de fallos de órganos.…”

“…Por ello, podría ser útil contar con un parámetro bioquímico disponible de forma rápida que proporcionase una información similar. Nuestro grupo había observado en esta misma cohorte de pacientes 8 que la región media de la proadrenomedulina (RM-proADM) también era capaz de predecir el riesgo de mortalidad (AUC: 0,866; IC del 95%: 0,810-0,921) y el número de fracaso de órganos (AUC: 0,922; 0,887-0,957). Al comparar las AUC, se hallaron diferencias estadística-mente significativas entre la RM-proADM y la RM-proPNA (p < 0,05), y entre la RM-proADM y la copeptina (p < 0,01).…”

“…La procalcitonina (PCT) surgió como marcador de sepsis 6 y, posteriormente, como ayuda en la clasificación de la gravedad y pronóstico de los pacientes 7 . La PCT podría utilizarse para identificar a niños con un mayor riesgo de mortalidad 8 . El péptido natriurético auricular (PNA) y la copeptina también demostraron asociación con la gravedad de los pacientes sépticos y la mortalidad de adultos en estado crítico [9][10][11][12][13][14][15][16] .…”

Comparative study of procalcitonin versus c-reactive protein in the diagnosis of sepsis in children below 16 years-a single centre observational study

“…Age group: Mean age of presentation in our study among asepsis and sepsis is 35.8 and 41.1 months; this age distribution corresponds to other study by Dominique Gendrel et al[12] with 2 subgroups with mean ages of 31.2 and 43.2 months. In a study by Corsino Rey et al[13] mean age was 43.2 months. In a study by Paolo Pecile et al,[8] mean age was 19 months with 66% < 1 yr.…”