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 AF, Ang, Juliana, Pallmann, Philip, Romaine, Sam T, Waldron, Cherry-Ann, Thomas-Jones, Emma, Miah, Nahida and Carrol, Enitan D ORCID: 0000-0001-8357-7726 (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.

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Official URL: http://dx.doi.org/10.1097/pcc.0000000000003075

Abstract

<h4>Objectives</h4>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.<h4>Design</h4>Secondary, nonprespecified analysis of prospectively collected dataset.<h4>Setting</h4>Pediatric Emergency Department in a United Kingdom tertiary center.<h4>Patients</h4>Children less than 16 years old presenting with fever and clinical indication for venous blood sampling ( n = 1,183).<h4>Interventions</h4>None.<h4>Measurements and main results</h4>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.<h4>Conclusions</h4>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
Uncontrolled Keywords:	adrenomedullin, Early Warning Score, emergency department, pediatrics, procalcitonin, risk stratification
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences > School of Medicine Faculty of Health and Life Sciences > Institute of Infection, Veterinary and Ecological Sciences
Depositing User:	Symplectic Admin
Date Deposited:	08 Nov 2022 15:31
Last Modified:	12 Jun 2023 09:20
DOI:	10.1097/PCC.0000000000003075
Open Access URL:	https://journals.lww.com/pccmjournal/Fulltext/9900...
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3166057