The kinetic profiles of copeptin and mid regional proadrenomedullin (MR-proADM) in pediatric lower respiratory tract infections

Abstract

Background Kinetics of copeptin and mid regional proadrenomedullin (MR-proADM) during febrile pediatric lower respiratory tract infections (LRTI) are unknown. We aimed to analyze kinetic profiles of copeptin and MR-proADM and the impact of clinical and laboratory factors on those biomarkers. Methods This is a retrospective post-hoc analysis of a randomized controlled trial, evaluating procalcitonin guidance for antibiotic treatment of LRTI (ProPAED-study). In 175 pediatric patients presenting to the emergency department plasma copeptin and MR-proADM concentrations were determined on day 1, 3, and 5. Their association with clinical characteristics and other inflammatory biomarkers were tested by non-linear mixed effect modelling. Results Median copeptin and MR-proADM values were elevated on day 1 and decreased during on day 3 and 5 (-26%; -34%, respectively). The initial concentrations of MR-proADM at inclusion were higher in patients receiving antibiotics intravenously compared to oral administration (difference 0.62 pmol/L, 95%CI 0.44;1.42, p<0.001). Intensive care unit (ICU) admission was associated with a daily increase of MR-proADM (increase/day 1.03 pmol/L, 95%CI 0.43;1.50, p<0.001). Positive blood culture in patients with antibiotic treatment and negative results on nasopharyngeal aspirates, or negative blood culture were associated with a decreasing MR-proADM (decrease/day -0.85 pmol/L, 95%CI -0.45;-1.44), p<0.001). Conclusion Elevated MR-proADM and increases thereof were associated with ICU admission suggesting the potential as a prognostic factor for severe pediatric LRTI. MR-proADM might only bear limited value for decision making on stopping antibiotics due to its slow decrease. Copeptin had no added value in our setting.

Monocyte, Lymphocyte and Neutrophil Ratios – Easy-to-Use Biomarkers for the Diagnosis of Pediatric Tuberculosis

“…For this analysis, we included data from two prospective, multicenter Swiss studies: the ongoing ChIldhood TubeRcUlosis in Switzerland (CITRUS) study (NCT03044509) 27 and the Procalcitonin guidance to reduce antibiotic treatment of lower respiratory tract infection in children and adolescents (ProPAED) study (ISRCTN 17057980). [28][29][30] For the CITRUS study all children <18 years evaluated for TB infection, TB disease or TB exposure in one of the nine participating centers in Switzerland (Bern, Basel, Zurich, Lausanne, Geneva, Aarau, St. Gallen, Lucerne, Bellinzona) were eligible. Written and signed consent was obtained by the children's guardians or by the adolescents and/or their guardians.…”

“…For this analysis, we included data from two prospective, multicenter Swiss studies: the ongoing ChIldhood TubeRcUlosis in Switzerland (CITRUS) study (NCT03044509) 27 and the Procalcitonin guidance to reduce antibiotic treatment of lower respiratory tract infection in children and adolescents (ProPAED) study (ISRCTN 17057980). 28 – 30 …”

Comprehensive Assessment of Mid-Regional Proadrenomedullin, Procalcitonin, Neuron-Specific Enolase and Protein S100 for Predicting Pediatric Severe Trauma Outcomes

“…Clinical data on the significance of ADM or MR-proADM levels in children with severe injuries for MOF prediction are lacking, as most studies have focused on adult groups. Existing published data mainly discuss the use of MR-proADM as a potential prognostic marker for the development of septic states in cases of various bacterial and viral infections [ 16 , 17 ]. MR-proADM did not demonstrate better diagnostic and prognostic accuracy as an independent predictor of septic conditions, compared to more common CRP and PCT biomarkers.…”

Antibiotic choice for respiratory infection in pediatric

“…In most countries, RTI is a common cause of hospitalisation in children under five years old [2]. RTI may result to complications like pleural effusions, empyema or necrotizing pneumonia [3].This disease is mild, self-limiting, and about 90% do not need therapy [4] but it can lead to economic burden. It is estimated that only upper respiratory infection costs about $22 billion per annum in healthcare systems worldwide [5].…”