Mid-regional pro-adrenomedullin in combination with pediatric early warning scores for risk stratification of febrile children presenting to the emergency department: secondary analysis of a nonprespecified United Kingdom cohort study

Lenihan, Rebecca A. F., Ang, Juliana, Pallmann, Philip ORCID: https://orcid.org/0000-0001-8274-9696, Romaine, Sam T., Waldron, Cherry-Ann ORCID: https://orcid.org/0000-0001-8465-2492, Thomas-Jones, Emma ORCID: https://orcid.org/0000-0001-7716-2786, Miah, Nahida and Carrol, Enitan D. 2022. Mid-regional pro-adrenomedullin in combination with pediatric early warning scores for risk stratification of febrile children presenting to the emergency department: secondary analysis of a nonprespecified United Kingdom cohort study. Pediatric Critical Care Medicine 23 (12) , pp. 980-989. 10.1097/PCC.0000000000003075

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Abstract

Objectives: Current sepsis guidelines do not provide good risk stratification of subgroups in whom prompt IV antibiotics and fluid resuscitation might of benefit. We evaluated the utility of mid-regional pro-adrenomedullin (MR-proADM) in identification of patient subgroups at risk of requiring PICU or high-dependency unit (HDU) admission or fluid resuscitation. Design: Secondary, nonprespecified analysis of prospectively collected dataset. Setting: Pediatric Emergency Department in a United Kingdom tertiary center. Patients: Children less than 16 years old presenting with fever and clinical indication for venous blood sampling (n = 1,183). Interventions: None. Measurements and Main Results: Primary outcome measures were PICU/HDU admission or administration of fluid resuscitation, with a secondary outcome of definite or probable bacterial infection. Biomarkers were measured on stored plasma samples and children phenotyped into bacterial and viral groups using a previously published algorithm. Of the 1,183 cases, 146 children (12.3%) required fluids, 48 (4.1%) were admitted to the PICU/HDU, and 244 (20.6%) had definite or probable bacterial infection. Area under the receiver operating characteristic (AUC) was used to assess performance. MR-proADM better predicted fluid resuscitation (AUC, 0.73; 95% CI, 0.67–0.78), than both procalcitonin (AUC, 0.65; 95% CI, 0.59–0.71) and Pediatric Early Warning Score (PEWS: AUC, 0.62; 95% CI, 0.56–0.67). PEWS alone showed good accuracy for PICU/HDU admission 0.83 (0.78–0.89). Patient subgroups with high MR-proADM (≥ 0.7 nmol/L) and high procalcitonin (≥ 0.5 ng/mL) had increased association with PICU/HDU admission, fluid resuscitation, and bacterial infection compared with subgroups with low MR-proADM (< 0.7 nmol/L). For children with procalcitonin less than 0.5 ng/mL, high MR-proADM improved stratification for fluid resuscitation only. Conclusions: High MR-proADM and high procalcitonin were associated with increased likelihood of subsequent disease progression. Incorporating MR-proADM into clinical risk stratification may be useful in clinician decision-making regarding initiation of IV antibiotics, fluid resuscitation, and escalation to PICU/HDU admission.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine Centre for Trials Research (CNTRR)
Publisher:	Lippincott, Williams & Wilkins
ISSN:	1529-7535
Date of First Compliant Deposit:	16 October 2022
Date of Acceptance:	31 July 2022
Last Modified:	03 May 2023 07:54
URI:	https://orca.cardiff.ac.uk/id/eprint/153441

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