Diagnostic and prognostic value of proadrenomedullin in neonatal sepsis

Abstract

PurposeSepsis is a major cause of neonatal morbidity and mortality. Early diagnosis is a major problem because of the lack of specific clinical signs. Therefore, a reliable diagnostic marker is needed to guide the use of antimicrobial agents. The objective of our study was to assess the value of proadrenomedullin (pro-ADM) in establishing the diagnosis and evaluating the prognosis of neonatal sepsis.MethodsThis study enrolled 60 newborn infants with sepsis proven with positive blood cultures and 30 healthy neonates. Complete blood count, C-reactive protein levels, and pro-ADM levels were obtained from all neonates.ResultsThe pro-ADM levels were significantly higher (14.39±0.75 nmol/L) in the sepsis group than in the control group (3.12±0.23 nmol/L). The optimal cutoff value for pro-ADM was 4.3 nmol/L, with a sensitivity of 93.3% and a specificity of 86.7%. The pro-ADM levels were also higher in nonsurvivors (P=0.001).ConclusionPro-ADM can be used as a reliable biomarker for neonatal sepsis. High pro-ADM levels were associated with mortality and could be an early indicator of disease outcome.

Differential Markers of Bacterial and Viral Infections in Children for Point-of-Care Testing

“…Although several studies have evaluated new markers or their combinations, most only address a specific infectious disease or specimen type, and thus do not allow generalization. In addition, patients with mild/localized infections or severe infections complicated by systemic involvement may display different levels of such biomarkers in serum [ 55 , 65 ]. Last but not least, underlying diseases (e.g., immunodeficiency or cancer) may impact on the performance of biomarkers because their levels generally rise in response to different inflammatory processes [ 46 , 66 ].…”

Proadrenomedullin in Sepsis and Septic Shock: A Role in the Emergency Department

“…Sepsis and septic shock are life-threatening medical emergencies characterized by severe systemic inflammation and organ dysfunction due to an excessive response to infections that may lead to death [ 1 , 2 , 3 , 4 , 5 , 6 ]. The definition of sepsis includes a dysregulated systemic inflammation, acute multi-organ dysfunction (i.e., cardiovascular, respiratory, and renal systems), and a deregulated immune response to a microbial invasion of the blood that is responsible of organ failure [ 7 , 8 , 9 , 10 ].…”

The Role of Pro-Adrenomedullin as a Marker of Severe Bacterial Infection in Children: A Review

“…In neonates, especially if preterm, levels of ProADM are physiologically elevated, requiring cut-off values for infection that are higher than those set in older children. Two different cut-offs (3.9 nmol/L and 4.3 nmol/L) [10,20] were significantly related to EOS, and, similarly to PCT, the ProADM trend in the first three days of life was a good predictor of neonatal mortality.…”

“…In this study, 4.3 nmol/L was identified as the optimal cut-off for ProADM: this value had a sensitivity of 93.3% and a specificity of 86.7%. The ProADM levels were also significantly higher in non-survivors (p = 0.001) [20].…”

“…ProADM was a reliable biomarker for neonatal sepsis. High ProADM levels were associated with mortality and were an early indicator of disease outcome [20] CRP: C-reactive protein; PCT: procalcitonin; CAP: community acquired pneumonia; AA: acute appendicitis.…”