Proadrenomedullin Predicts Severe Disease in Children With Suspected Community-acquired Pneumonia

被引:20
作者
Florin, Todd A. [1 ,2 ]
Ambroggio, Lilliam [3 ,4 ]
Brokamp, Cole [5 ,6 ]
Zhang, Yin [5 ,6 ]
Nylen, Eric S. [7 ]
Rattan, Mantosh [8 ,9 ]
Crotty, Eric [8 ,9 ]
Belsky, Michael A. [10 ]
Krueger, Sara [9 ]
Epperson, Thomas N. [11 ]
Kachelmeyer, Andrea [6 ,12 ]
Ruddy, Richard M. [6 ,12 ]
Shah, Samir S. [6 ,13 ,14 ]
机构
[1] Ann & Robert H Lurie Childrens Hosp Chicago, Div Emergency Med, 225 East Chicago Ave,Box 62, Chicago, IL 60611 USA
[2] Northwestern Univ, Feinberg Sch Med, Dept Pediat, Chicago, IL 60611 USA
[3] Univ Colorado, Dept Pediat, Childrens Hosp Colorado, Sect Emergency Med, Aurora, CO USA
[4] Univ Colorado, Dept Pediat, Childrens Hosp Colorado, Sect Hosp Med, Aurora, CO USA
[5] Univ Cincinnati, Coll Med, Cincinnati Childrens Hosp Med Ctr, Div Biostat & Epidemiol, Cincinnati, OH USA
[6] Univ Cincinnati, Coll Med, Dept Pediat, Cincinnati, OH USA
[7] Vet Affairs Med Ctr, Dept Endocrinol, 50 Irving St NW, Washington, DC 20422 USA
[8] Cincinnati Childrens Hosp Med Ctr, Dept Radiol, Cincinnati, OH 45229 USA
[9] Univ Cincinnati, Coll Med, Cincinnati, OH USA
[10] Univ Pittsburgh, Sch Med, Pittsburgh, PA USA
[11] Univ Louisville, Sch Med, Louisville, KY 40292 USA
[12] Univ Cincinnati, Coll Med, Cincinnati Childrens Hosp Med Ctr, Div Emergency Med, Cincinnati, OH USA
[13] Univ Cincinnati, Coll Med, Cincinnati Childrens Hosp Med Ctr, Div Hosp Med, Cincinnati, OH USA
[14] Univ Cincinnati, Coll Med, Cincinnati Childrens Hosp Med Ctr, Div Infect Dis, Cincinnati, OH USA
基金
美国国家卫生研究院;
关键词
pneumonia; biomarkers; children; emergency medicine; proadrenomedullin; PRO-ADRENOMEDULLIN; SEPSIS; PROCALCITONIN; ACCURACY; PLASMA; SCORE;
D O I
10.1093/cid/ciaa1138
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background. 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. Methods. 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. Results. 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. Conclusions. ProADM was associated with severe disease and discriminated moderately well children who developed severe disease from those who did not, particularly in radiographic CAP.
引用
收藏
页码:E524 / E530
页数:7
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