Proadrenomedullin and copeptin in pediatric pneumonia: a prospective diagnostic accuracy study

Abstract

BackgroundCommunity-acquired-pneumonia is the leading cause of child mortality worldwide. Very few studies have explored the predictive value of Proadrenomedullin and Copeptin in pediatric severe pneumonia and bacteremia.MethodsProadrenomedullin and Copeptin were assessed as predictors for complicated community-acquired pneumonia (bacteremia, empyema) in 88 children aged 0 to 16 years presenting to the pediatric emergency department, using B.R.A.H.M.S. Kryptor Compact pro-ADM and Copeptin with the TRACE technology (time-resolved amplified cryptase emission). STARD standard reporting was used.ResultsA complicated community-acquired pneumonia was found in 11 out of 88 children (12.5 %). Proadrenomedullin median values increased more than twofold, in complicated vs. uncomplicated (0.18 vs. 0.08 nmol/L, p = 0.039), and fivefold in bacteremic vs. non-bacteremic pneumonia (0.40 vs. 0.08 nmol/L, p = 0.02). Proadrenomedullin > 0.16 nmol/L showed 100 % sensitivity (95 % CI 39.8 – 100.0) and 70 % (95 % CI 58.7 – 79.7) specificity for bacteremia. Copeptin showed no added-value.ConclusionsProadrenomedullin seems a reliable and available predictor for complicated CAP, and could therefore help the physician with the decision to hospitalize, and choose the antibiotics administration route. Larger studies are needed.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-015-1095-5) contains supplementary material, which is available to authorized users.

Host-response biomarkers for the diagnosis of bacterial respiratory tract infections

“…In pediatric patients with uncomplicated CAP and CAP complicated with bacteremia and/or empyema, copeptin was not identified as a relevant biomarker [9]. However, this is the same secondary analysis that investigated sTREM-1 and copeptin and was not associated with statistical power calculation.…”

“…The evidence of proadrenomedullin to support the diagnosis of bacterial RTIs is inconsistent. One study with pediatric patients with complicated and bacteremia-associated pneumonia vs. pleural empyema showed 100% sensitivity and could accurately distinguish between these patient groups (AUROC >0.85) with a sensitivity and specificity comparable to CRP [9]. However, no specific statistical power calculation was performed as this study was a secondary analysis.…”

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

“…A significant difference in ProADM median values was again found in complicated cases (0.18 vs. 0.08 nmol/L, p = 0.039) and in bacteraemic CAP (0.40 vs. 0.08 nmol/L, p = 0.02). A cut off of ProADM > 0,16 nmol/L had 100% sensitivity (95% CI 39.8-100.0) and 70% specificity (95% CI 58.7-79.7) for bacteraemia and a cut off of 0.16 nmol/L was as accurate as CRP <100 mg/L and better than band neutrophils (<1.5 G/L) or leucocytosis (<15 WBC/L) to rule out bacteraemia (sensitivity and NPV = 10%) [14].…”

Diagnostic Value of Mid-regional Pro-adrenomedullin (MR-proADM) as a Biomarker of Invasive Bacterial Infection in Children: A Systematic Review.

“…All of the 323 studies screened and excluded were not relevant to the systematic review. There were 11 full text articles that underwent full review, and six studies were eligible for inclusion in the nal systematic review [18][19][20][21][22][23][24][25][26][27][28].…”

“…Of the ve excluded studies four were excluded because the index test was Adrenomedullin and not MR-proADM and one study was excluded because it only reported the differences in cord blood concentrations of MR-proADM in newborns with and without risk factors for infection [24][25][26][27][28]. Two of the six eligible studies reported on adult and paediatric data [22,23].…”