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Diagnostic and prognostic value of procalcitonin and mid-regional pro-adrenomedullin in septic paediatric patients

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Abstract

Early diagnosis of sepsis and its severity stratification at admission is critical to improve patient outcomes and to ensure the optimal use of health care resources. In order to assess the diagnostic potential of mid-regional pro-adrenomedullin (MR-proADM) in septic paediatric patients in comparison with procalcitonin (PCT), and to evaluate the usefulness of a single early determination of MR-proADM as a stratification and severity prediction tool, a prospective observational study was conducted. Seventy-three paediatric patients with a suspicion of sepsis were included. A single blood test was carried out at initial time to analyse infection biomarkers. PCT values were significantly higher in septic patients in comparison with non-septic patients (p = 0.03) with an AUC of 0.748 (p = 0.003). Levels of MR-proADM significantly increased in patients with severe sepsis (p = 0.048), with an AUC of 0.729 (p = 0.013). MR-proADM showed a positive correlation with pSOFA, PRISM III, and PELOD-2 severity scores. Levels of MR-proADM were significantly higher in patients who required vasoactive drugs (p = 0.02) or presented renal dysfunction (p = 0.004).

Conclusion: PCT appeared to be superior to MR-proADM in diagnosing sepsis. Determining MR-proADM plasma levels at the initial phase of sepsis could be a useful tool for sepsis stratification and morbidity prediction before organ failure occurs. The present results need to be assessed with larger sample size studies.

What is Known:

•CRP and PCT are already included in clinical practice to assess sepsis and estimate disease severity, although their sensitivity and specificity are lower than desired.

•ADM is a protein that has immune and vascular modulation actions, and its blood levels are increased in adult and paediatric sepsis.

•ADM is a promising tool for early diagnosis and prognostic assessment in adult sepsis.

What is New:

•PCT appeared to be superior to MR-proADM in diagnosing paediatric sepsis.

•MR-proADM plasma levels could be a useful tool for paediatric sepsis stratification and morbidity prediction.

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Abbreviations

ACCM:

American College of Critical Care Medicine

APACHE II:

Acute Physiology and Chronic Health disease Classification System II

AUC:

Area under the curve

CRP:

C-reactive protein.

GNB:

Gram-negative bacilli

GNC:

Gram-negative cocci

GNCB:

Gram-negative cocci-bacilli

GPC:

Gram-positive cocci

ICU:

Intensive care unit

IQR:

Interquartile ranges

L:

Litre

LH+:

Likelihood ratio

LOS:

Length of hospitalization

ml:

Millilitre

MR-proADM:

Mid-regional pro-adrenomedullin

MV:

Mechanical ventilation

ng:

Nanogram

nmol:

Nanomol

NPV:

Negative predictive value

PCT:

Procalcitonin

PELOD-2:

Paediatric Logistic Organ Dysfunction Score-2

PICU:

Paediatric Intensive Care Unit

PPV:

Positive predictive value

PRISM III:

Paediatric Risk of Mortality Score III

pSOFA:

paediatric Sequential Organ Failure Assessment

ROC:

Receiver operating characteristic

SAPS II:

Simplified Acute Physiology Score

Se:

Sensitivity

SOFA:

Sequential Organ Failure Assessment

SP:

Specificity

TRACE:

Time-Resolved Amplified Cryptate Emission

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Authors and Affiliations

  1. Paediatric Intensive Care Unit Service, Hospital Sant Joan de Déu, University of Barcelona, Passeig de Sant Joan de Déu number 2, 08950, Barcelona, Esplugues de Llobregat, Spain

    Anna Solé-Ribalta, Sara Bobillo-Pérez, Monica Girona-Alarcón, Francisco José Cambra, Iolanda Jordan & Elisabeth Esteban

  2. Immunological and Respiratory Disorders in the Paediatric Critical Patient Research Group, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Barcelona, Spain

    Anna Solé-Ribalta, Sara Bobillo-Pérez, Monica Girona-Alarcón, Francisco José Cambra, Iolanda Jordan & Elisabeth Esteban

  3. Biochemistry Laboratory at the Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain

    Anna Valls

  4. Paediatric Emergency Transport Team, Hospital de Sant Joan de Déu, Barcelona, Spain

    Monica Girona-Alarcón & Elisabeth Esteban

  5. Paediatric Infectious Diseases Research Group, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, CIBERESP, Barcelona, Spain

    Cristian Launes & Iolanda Jordan

  6. Department of Paediatrics, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain

    Cristian Launes

Authors
  1. Anna Solé-Ribalta
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  2. Sara Bobillo-Pérez
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  3. Anna Valls
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  4. Monica Girona-Alarcón
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  5. Cristian Launes
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  6. Francisco José Cambra
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  7. Iolanda Jordan
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  8. Elisabeth Esteban
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Contributions

All authors made substantial contributions to the study:Anna Solé-Ribalta contributed on conceptualization and design, methodology, investigation, data curation and formal analysis; Sara Bobillo-Pérez contributed on investigation, data curation and formal analysisAnna Valls contributed on methodology; Monica Girona-Alarcón contributed on conceptualization and design and investigation; Cristian Launes contributed on methodology and supervision; Francisco José Cambra contributed on investigation and supervision;Iolanda Jordán contributed on conceptualization and design, methodology, formal analysis and supervision;Elisabeth Esteban contributed on investigation formal analysis and supervision.

All authors also participated in the writing and/or revision of the manuscript: Anna Solé-Ribalta, Sara Bobillo-Pérez, Anna Valls, Monica Girona-Alarcon participated in drafting the initial manuscript; Anna Solé-Ribalta, Cristian Launes, Francisco José Cambra, Iolanda Jordan and Elisabeth Esteban participated in review and editing the manuscript.

All authors gave the final approval of the version to be published and agreed to be accountable for all aspects of the work.

Corresponding author

Correspondence to Iolanda Jordan.

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The authors declare that they have no conflict of interest.

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Communicated by Nicole Ritz

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Solé-Ribalta, A., Bobillo-Pérez, S., Valls, A. et al. Diagnostic and prognostic value of procalcitonin and mid-regional pro-adrenomedullin in septic paediatric patients. Eur J Pediatr 179, 1089–1096 (2020). https://doi.org/10.1007/s00431-020-03587-7

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  • DOI: https://doi.org/10.1007/s00431-020-03587-7

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