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Diagnostic Efficacy of Serum Amyloid A Protein and Soluble Intercellular Adhesion Molecule 1 in Pediatric
Hamdy H Abo-Hagar1, Ahmed Abd ElBasset Abo-Elezz1, Mostafa Mehrez1
11 Pediatric Intensive Care Unit, Faculty of Medicine, Pediatric Department, Tanta University, Gharbia Governorate, Tanta, Egypt.
Insights
Serum amyloid A (SAA) and soluble intercellular adhesion molecule 1 (sICAM-1) show promise for early detection of ventilator-associated pneumonia (VAP) in children. These biomarkers, especially when combined with the clinical pulmonary infection score (CPIS), can also predict patient survival.
Area of Science:
- Pediatric critical care medicine
- Infectious disease diagnostics
- Biomarker research
Background:
- Ventilator-associated pneumonia (VAP) is a significant complication in pediatric intensive care.
- Early and accurate diagnosis of VAP is crucial for timely treatment and improved patient outcomes.
- Current diagnostic methods may have limitations in sensitivity and specificity.
Purpose of the Study:
- To evaluate the utility of serum amyloid A (SAA) protein, soluble intercellular adhesion molecule 1 (sICAM-1), and C-reactive protein (CRP) as early detection markers for VAP in children.
- To assess the predictive value of these biomarkers for VAP outcomes, including mortality.
- To compare the diagnostic performance of these biomarkers with the modified clinical pulmonary infection score (CPIS).
Main Methods:
- A cohort of 35 children requiring mechanical ventilation for over 48 hours (excluding pneumonia) was studied.
- Serum levels of SAA, sICAM-1, and CRP were measured at the start and on day 3 of mechanical ventilation.
- Endotracheal aspirate cultures and modified CPIS were performed concurrently.
Main Results:
- VAP was diagnosed in 6 (17.1%) patients using CPIS.
- Significant increases in serum SAA, sICAM-1, and CRP levels were observed by day 3 of mechanical ventilation in VAP patients.
- SAA and sICAM-1 demonstrated 100% sensitivity for VAP prediction; combining SAA with CPIS achieved 100% specificity.
- SAA and sICAM-1 also showed high sensitivity (100%) for predicting non-survival in VAP patients.
Conclusions:
- Serum SAA and sICAM-1 are reliable biomarkers for the early detection of VAP in children.
- Combining serum SAA with CPIS enhances diagnostic specificity for VAP to 100%.
- Serum SAA measurement is a valuable tool for predicting non-survival in pediatric VAP cases.
Objectives:
Study of inflammatory biomarkers which may aid in early detection of ventilator-associated pneumonia (VAP) in children and predicting their outcome.
Patients:
Thirty-five children, aged 2 months to 13 years, needed mechanical ventilation (MV) for more than 48 hours due to causes other than pneumonia.
Methods:
Measurement of serum amyloid A (SAA) protein, soluble intercellular adhesion molecule 1 (sICAM-1), and C-reactive protein (CRP), modified clinical pulmonary infection score (CPIS) and performing culture of endotracheal aspirate at the start and on the third day of MV.
Results:
Ventilator-associated pneumonia was diagnosed by CPIS in 6 (17.1%) of 35 patients. On the third day of MV, there was a significant increase in serum mean levels of SAA, sICAM-1, and CRP in comparison to the start of MV ( P = .005, .004, and .01, respectively). Three (50%) of 6 patients with VAP died, while 4 (14.28%) of 28 patients without VAP died. The sensitivity of serum SAA, sICAM-1, and CPIS were 100% for predicting VAP, while specificity was highest for CPIS (96.55%) followed by SAA (93.1%). Combination of CPIS and SAA increased the specificity to 100%. For predicting nonsurvival, serum SAA and sICAM-1 had a sensitivity of 100% and a specificity of 92.86% and 89.29%, respectively.
Conclusion:
Serum amyloid A and sICAM-1 may be considered as reliable markers for detection of VAP. Combination of serum SAA with CPIS increased the specificity to 100%. Measurement of SAA in patients with VAP also had a good predictive value for nonsurvival in such patients.
