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Proadrenomedullin Predicts Severe Disease in Children With Suspected Community-acquired Pneumonia
Todd A Florin1, Lilliam Ambroggio2, Cole Brokamp3
1Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, and Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Insights
Proadrenomedullin (proADM) effectively predicts severe community-acquired pneumonia (CAP) in children. Higher proADM levels correlate with increased disease severity, aiding in identifying at-risk pediatric patients.
Area of Science:
- Pediatric infectious diseases
- Biomarker research
- Critical care medicine
Background:
- Proadrenomedullin (proADM) is a peptide known for its vasodilatory, antimicrobial, and anti-inflammatory effects.
- In adults, proADM is a stronger predictor of severe community-acquired pneumonia (CAP) than C-reactive protein or procalcitonin.
- The predictive value of proADM for CAP severity in children remains to be fully elucidated.
Purpose of the Study:
- To evaluate the capability of proADM in predicting disease severity across various clinical outcomes in children with suspected CAP.
- To compare the predictive performance of proADM against established severity markers in pediatric CAP.
Main Methods:
- A prospective cohort study involving 369 children aged 3 months to 18 years diagnosed with CAP in an emergency department setting.
- Disease severity was categorized into mild, mild-moderate, moderate-severe, and severe based on clinical criteria.
- Proportional odds logistic regression was employed to analyze the association between proADM levels and disease severity, with adjustments for relevant clinical factors.
Main Results:
- Median proADM levels demonstrated a statistically significant increase with escalating CAP severity (P=.002).
- ProADM was significantly associated with increased odds of severe outcomes in both suspected CAP (OR, 1.68) and radiographic CAP (OR, 2.11) cohorts.
- The area under the curve (AUC) for proADM was 0.64 for suspected CAP and 0.77 for radiographic CAP, indicating moderate predictive ability, particularly in confirmed radiographic cases.
Conclusions:
- Proadrenomedullin (proADM) is associated with severe disease in pediatric CAP.
- ProADM demonstrates moderate ability to discriminate between children with and without severe CAP, especially when radiographic evidence is present.
- These findings suggest proADM's potential utility as a biomarker for assessing CAP severity in children.
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.
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