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Diagnostic and prognostic value of proadrenomedullin in neonatal sepsis

  • Received : 2017.11.25
  • Accepted : 2018.03.26
  • Published : 2018.05.15

Abstract

Purpose: Sepsis is a major cause of neonatal morbidity and mortality. Early diagnosis is a major problem because of the lack of specific clinical signs. Therefore, a reliable diagnostic marker is needed to guide the use of antimicrobial agents. The objective of our study was to assess the value of proadrenomedullin (pro-ADM) in establishing the diagnosis and evaluating the prognosis of neonatal sepsis. Methods: This study enrolled 60 newborn infants with sepsis proven with positive blood cultures and 30 healthy neonates. Complete blood count, C-reactive protein levels, and pro-ADM levels were obtained from all neonates. Results: The pro-ADM levels were significantly higher ($14.39{\pm}0.75nmol/L$) in the sepsis group than in the control group ($3.12{\pm}0.23nmol/L$). The optimal cutoff value for pro-ADM was 4.3 nmol/L, with a sensitivity of 93.3% and a specificity of 86.7%. The pro-ADM levels were also higher in nonsurvivors (P=0.001). Conclusion: Pro-ADM can be used as a reliable biomarker for neonatal sepsis. High pro-ADM levels were associated with mortality and could be an early indicator of disease outcome.

Keywords

References

  1. Shi J, Tang J, Chen D. Meta­-analysis of diagnostic accuracy of neu­ trophil CD64 for neonatal sepsis. Ital J Pediatr 2016;42:57. https://doi.org/10.1186/s13052-016-0268-1
  2. Cernada M, Serna E, Bauerl C, Collado MC, Perez­Martínez G, Vento M. Genome­wide expression profiles in very low birth weight infants with neonatal sepsis. Pediatrics 2014;133:e1203­-11. https://doi.org/10.1542/peds.2013-2552
  3. Delanghe JR, Speeckaert MM. Translational research and biomarkers in neonatal sepsis. Clin Chim Acta 2015;451(Pt A):46-­64. https://doi.org/10.1016/j.cca.2015.01.031
  4. Tang BM, Eslick GD, Craig JC, McLean AS. Accuracy of procalcitonin for sepsis diagnosis in critically ill patients: systematic review and meta­analysis. Lancet Infect Dis 2007;7:210-­7. https://doi.org/10.1016/S1473-3099(07)70052-X
  5. Morgenthaler NG, Struck J, Alonso C, Bergmann A. Measurement of midregional proadrenomedullin in plasma with an immunolumino­ metric assay. Clin Chem 2005;51:1823­-9. https://doi.org/10.1373/clinchem.2005.051110
  6. Christ­Crain M, Morgenthaler NG, Struck J, Harbarth S, Bergmann A, Müller B. Mid­regional pro­adrenomedullin as a prognostic marker in sepsis: an observational study. Crit Care 2005;9:R816­-24. https://doi.org/10.1186/cc3885
  7. Fahmey SS. Early­onset sepsis in a neonatal intensive care unit in Beni Suef, Egypt: bacterial isolates and antibiotic resistance pattern. Korean J Pediatr 2013;56:332­-7. https://doi.org/10.3345/kjp.2013.56.8.332
  8. Mussap M. Laboratory medicine in neonatal sepsis and inflammation. J Matern Fetal Neonatal Med 2012;25 Suppl 4:32-­4.
  9. Benito J, Luaces­Cubells C, Mintegi S, Astobiza E, Martinez­Indart L, Valls­Lafont A, et al. Lack of value of midregional pro­adrenome­ dullin and C­terminal pro­endothelin­1 for prediction of severe bac­ terial infections in infants with fever without a source. Eur J Pediatr 2013;172:1441­-9. https://doi.org/10.1007/s00431-013-2062-z
  10. Admaty D, Benzing J, Burkhardt T, Lapaire O, Hegi L, Szinnai G, et al. Plasma midregional proadrenomedullin in newborn infants: impact of prematurity and perinatal infection. Pediatr Res 2012;72:70-­6. https://doi.org/10.1038/pr.2012.38
  11. Angeletti S, Spoto S, Fogolari M, Cortigiani M, Fioravanti M, De Florio L, et al. Diagnostic and prognostic role of procalcitonin (PCT) and MR­pro­Adrenomedullin (MR­proADM) in bacterial infections. APMIS 2015;123:740­-8. https://doi.org/10.1111/apm.12406
  12. Oncel MY, Dilmen U, Erdeve O, Ozdemir R, Calisici E, Yurttutan S, et al. Proadrenomedullin as a prognostic marker in neonatal sepsis. Pediatr Res 2012;72:507­-12. https://doi.org/10.1038/pr.2012.106
  13. Cao Y, Xia Q, Chen C, Yang Y. Precursors of adrenomedullin, endo­ thelin and atrial natriuretic peptide as diagnostic markers of neonatal infection. Acta Paediatr 2012;101:242-­6. https://doi.org/10.1111/j.1651-2227.2011.02511.x
  14. Abd Elmouttaleb AT, Aly HA, Bayomy EM, Abdelhamed MR, Esmael NF. Plasma procalcitonin and proadrenomedullin concentrations as predictive markers for early onset neonatal sepsis. Am J Biochem 2016;6:6-­15.
  15. Wang RL, Kang FX. Prediction about severity and outcome of sepsis by pro­atrial natriuretic peptide and pro­adrenomedullin. Chin J Traumatol 2010;13:152­-7.
  16. Silveira RC, Procianoy RS. Evaluation of interleukin­6, tumour necrosis factor­alpha and interleukin­1beta for early diagnosis of neonatal sepsis. Acta Paediatr 1999;88:647-­50. https://doi.org/10.1080/08035259950169314
  17. Debiane L, Hachem RY, Al Wohoush I, Shomali W, Bahu RR, Jiang Y, et al. The utility of proadrenomedullin and procalcitonin in compari­ son to C­reactive protein as predictors of sepsis and bloodstream in­ fections in critically ill patients with cancer*. Crit Care Med 2014;42: 2500-­7. https://doi.org/10.1097/CCM.0000000000000526
  18. Angeletti S, Battistoni F, Fioravanti M, Bernardini S, Dicuonzo G. Pro­ calcitonin and mid­regional pro­adrenomedullin test combination in sepsis diagnosis. Clin Chem Lab Med 2013;51:1059­-67.

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  1. The Role of Pro-Adrenomedullin as a Marker of Severe Bacterial Infection in Children: A Review vol.2, pp.3, 2018, https://doi.org/10.3390/reports2030017
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