Proadrenomedullin and copeptin in pediatric pneumonia: a prospective diagnostic accuracy study.
BACKGROUND
Community-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.


METHODS
Proadrenomedullin 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.


RESULTS
A 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.


CONCLUSIONS
Proadrenomedullin 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.
Pediatric Emergency Division, Geneva University Hospitals (HUG), Rue Gabrielle Perret-Gentil 6, 1211, Geneva 14, Switzerland. gabriel.alcoba@hcuge.ch.|Tropical & Humanitarian Medicine Division, Geneva University Hospitals (HUG), Rue Gabrielle Perret-Gentil 6, 1211, Geneva 14, Switzerland. gabriel.alcoba@hcuge.ch.
Gabriel
G
Alcoba
Pediatric Emergency Division, Geneva University Hospitals (HUG), Rue Gabrielle Perret-Gentil 6, 1211, Geneva 14, Switzerland. sergio.manzano@hcuge.ch.
Sergio
S
Manzano
Pediatric Emergency Division, Geneva University Hospitals (HUG), Rue Gabrielle Perret-Gentil 6, 1211, Geneva 14, Switzerland. laurence.lacroix@hcuge.ch.
Laurence
L
Lacroix
Pediatric Emergency Division, Geneva University Hospitals (HUG), Rue Gabrielle Perret-Gentil 6, 1211, Geneva 14, Switzerland. annick.galetto@hcuge.ch.
Annick
A
Galetto-Lacour
Pediatric Emergency Division, Geneva University Hospitals (HUG), Rue Gabrielle Perret-Gentil 6, 1211, Geneva 14, Switzerland. alain.gervaix@hcuge.ch.
Alain
A
Gervaix
D000293:Adolescent; D053607:Adrenomedullin / Q000097:blood*; D016470:Bacteremia / Q000097:blood* / Q000150:complications / Q000175:diagnosis; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000097:blood / Q000150:complications / Q000175:diagnosis; D004636:Emergency Service, Hospital; D016724:Empyema, Pleural / Q000097:blood* / Q000150:complications / Q000175:diagnosis; D005260:Female; D006020:Glycopeptides / Q000097:blood*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D018410:Pneumonia, Bacterial / Q000097:blood* / Q000150:complications / Q000175:diagnosis; D011379:Prognosis; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D012680:Sensitivity and Specificity
D015415:Biomarkers; D006020:Glycopeptides; D011498:Protein Precursors; C048197:copeptins; C088633:proadrenomedullin; D053607:Adrenomedullin