Paediatric Infections and Organ Dysfunction

The availability of accurate tools to rapidly assess the risk of critically ill children on admission, or during the first 24 hours, to the Pediatric Intensive Care Unit (PICU) is of critical importance Ref-1. Commonly used tools include the Pediatric Risk of Mortality (PRISM III), the Pediatric Index of Mortality (PIM 2) Ref-2-5 and the Pediatric Logistic Organ Dysfunction (PELOD) scores, however, whilst these tools can be useful in predicting the evolution of a wide group of patients, their utility with regards to individual patients appears to be limited Ref-6, complex to determine Ref-7, and more suited to an audit and research environment rather than in clinical decision making Ref-2,5,6.

The availability of a rapid and accurate biomarker test, therefore, to provide similar or improved risk assessment values, can greatly aid clinical decision making and earlier treatment intervention. A study by Rey et al. (2013) Ref-1 separated 254 pediatric admissions into mortality risk and organ failure groups, and found that CRP, PCT and MR-proADM values were increased in patients with a higher mortality risk, and in those with more than one organ failure. However, MR-proADM clearly had greater sensitivity, specificity and for both mortality risk and organ failure.

mr proadm organ failure auc valuesSensitivity and specificity values of MR-proADM, PCT and CRP in PICU mortality risk and organ failure groups

 

Enhanced mortality and organ failure predictions

An analysis of AUC values for risk mortality scores and organ failures show extremely high values for MR-proADM (overall AUCs of 0.866 and 0.922 respectively). This is also the case for risk mortality scores in the presence of an infection (AUC of 0.869), and organ failure scores in both the presence and absence of an infection (AUCs of 0.943 and 0.901 respectively). Accordingly, this highlights strength of MR-proADM in both predicting the risk of developing organ failure and mortality in pediatrics.

mr proadm organ failure sensitivityAUC values for MR-proADM, PCT and CRP for risk mortality groups (total sample and with an infection) and organ failure groups (total sample, with and without an infection)

References Paediatric infections and organ dysfunction

Ref-1: Rey C, Garcia-Hernandez I, Concha A, et al. Pro-adrenomedullin, pro-endothelin-1, procalcitonin, C-reactive protein and mortality risk in critically ill children: a prospective study. Crit Care. 2013;17(5):R240.

Ref-2: Marcin JP, Pollack MM. Review of the methodologies and applications of scoring systems in neonatal and pediatric intensive care. Pediatr Crit Care Med. Jul 2000;1(1):20-27.

Ref-3: Pollack MM, Patel KM, Ruttimann UE. PRISM III: an updated Pediatric Risk of Mortality score. Crit Care Med. May 1996;24(5):743-752.

Ref-4: Prieto Espunes S, Lopez-Herce Cid J, Rey Galan C, Medina Villanueva A, Concha Torre A, Martinez Camblor P. [Prognostic indexes of mortality in pediatric intensive care units]. An Pediatr (Barc). Apr 2007;66(4):345-350.

Ref-5: Shann F, Pearson G, Slater A, Wilkinson K. Paediatric index of mortality (PIM): a mortality prediction model for children in intensive care. Intensive Care Med. Feb 1997;23(2):201-207.

Ref-6: Slater A, Shann F, Pearson G. PIM2: a revised version of the Paediatric Index of Mortality. Intensive Care Med. Feb 2003;29(2):278-285.

Ref-7: Lacroix J, Cotting J. Severity of illness and organ dysfunction scoring in children. Pediatr Crit Care Med. May 2005;6(3 Suppl):S126-134. 41. Jordan I, Corniero P, Balaguer M, et al. Adrenomedullin is a useful biomarker for the prognosis of critically ill septic children. Biomark Med. Oct 2014;8(9):1065-1072.

Ref-8: Jordan I, Corniero P, Balaguer M, et al. Adrenomedullin is a useful biomarker for the prognosis of critically ill septic children. Biomark Med. Oct 2014;8(9):1065-1072.

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