Urinary Proadrenomedullin and Disease Severity in Children With Suspected Community-acquired Pneumonia.
Urinary Proadrenomedullin and Disease Severity in Children With Suspected Community-acquired Pneumonia.
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DOI：
10.1097/inf.0000000000003336
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发表时间：
2021-12-01
期刊：
影响因子：
--
通讯作者：
Balmert L
中科院分区：
文献类型：
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作者：
Florin TA;Ambroggio L;Shah SS;Ruddy RM;Nylen ES;Balmert L
血浆肾上腺髓质素原（proADM）是预测社区获得性肺炎（CAP）疾病严重程度的一个有前途的生物标志物。尿液生物标志物提供优于血液的优势，包括易于收集。我们评估了尿proADM与儿科CAP疾病严重程度之间的关系。我们对3个月至18岁的CAP儿童进行了一项前瞻性队列研究。计算尿proADM/肌酐（Cr）。疾病严重程度定义为：轻度（出院回家）、轻度-中度（住院但非中度-重度或重度）、中度-重度（例如，住院补充氧气，并发肺炎），和严重（例如，血管加压药、有创通气）。使用逻辑回归检查疑似CAP队列和放射学CAP子集的结局。在纳入的427名儿童中，当调整其他协变量时，与非严重疾病相比，较高的proADM/Cr与严重疾病的几率增加相关（疑似CAP，比值比（OR）1.02 [95%置信区间（CI）1.003，1.04];放射学CAP，OR 1.03 [95% CI 1.01，1.06]）。ProADM/Cr的受试者工作特征（ROC）曲线下面积为0.56（阈值0.9 pmol/mg），用于区分疑似CAP中的重度和非重度疾病，在放射学CAP中为0.65（阈值0.82 pmol/mg）。健康对照组尿液中的proADM（中位数，0.61 pmol/mg）低于疑似CAP（0.87 pmol/mg，p=0.018）和放射学检查（0.73 pmol/mg，p=0.016）CAP。在艾德就诊时测量的尿proADM/Cr比值与CAP儿童严重结局的发展有统计学相关性，在放射学疾病中具有更强的区分能力。
Plasma proadrenomedullin (proADM) is a promising biomarker to predict disease severity in community-acquired pneumonia (CAP). Urinary biomarkers offer advantages over blood, including ease of collection. We evaluated the association between urinary proADM and disease severity in pediatric CAP. We performed a prospective cohort study of children 3 months to 18 years with CAP. Urinary proADM/creatinine (Cr) was calculated. Disease severity was defined as: mild (discharged home), mild-moderate (hospitalized but not moderate-severe or severe), moderate-severe (e.g., hospitalized with supplemental oxygen, complicated pneumonia), and severe (e.g., vasopressors, invasive ventilation). Outcomes were examined using logistic regression within the cohort with suspected CAP and in a subset with radiographic CAP. Of the 427 children included, higher proADM/Cr was associated with increased odds of severe disease compared with non-severe disease (suspected CAP, odds ratio (OR) 1.02 [95% confidence interval (CI) 1.003, 1.04]; radiographic CAP, OR 1.03 [95% CI 1.01, 1.06]) when adjusted for other covariates. ProADM/Cr had an area under the receiver operating characteristic (ROC) curve of 0.56 (threshold 0.9 pmol/mg) to differentiate severe from non-severe disease in suspected CAP and 0.65 in radiographic CAP (threshold 0.82 pmol/mg). Healthy controls had less proADM in their urine (median, 0.61 pmol/mg) compared with suspected (0.87 pmol/mg, p=0.018) and radiographic (0.73 pmol/mg, p=0.016) CAP. Urinary proADM/Cr ratio measured at the time of ED visit was statistically associated with development of severe outcomes in children with CAP, with stronger discriminatory performance in radiographic disease.