Abstract
Kinetics of copeptin and mid regional proadrenomedullin (MR-proADM) during febrile pediatric lower respiratory tract infections (LRTI) are unknown. We aimed to analyze kinetic profiles of copeptin and MR-proADM and the impact of clinical and laboratory factors on those biomarkers. This is a retrospective post-hoc analysis of a randomized controlled trial, evaluating procalcitonin guidance for antibiotic treatment of LRTI (ProPAED-study). In 175 pediatric patients presenting to the emergency department plasma copeptin and MR-proADM concentrations were determined on day 1, 3, and 5. Their association with clinical characteristics and other inflammatory biomarkers were tested by non-linear mixed effect modelling. Median copeptin and MR-proADM values were elevated on day 1 and decreased during on day 3 and 5 (-26%; -34%, respectively). The initial concentrations of MR-proADM at inclusion were higher in patients receiving antibiotics intravenously compared to oral administration (difference 0.62 pmol/L, 95%CI 0.44;1.42, p<0.001). Intensive care unit (ICU) admission was associated with a daily increase of MR-proADM (increase/day 1.03 pmol/L, 95%CI 0.43;1.50, p<0.001). Positive blood culture in patients with antibiotic treatment and negative results on nasopharyngeal aspirates, or negative blood culture were associated with a decreasing MR-proADM (decrease/day -0.85 pmol/L, 95%CI -0.45;-1.44), p<0.001). Elevated MR-proADM and increases thereof were associated with ICU admission suggesting the potential as a prognostic factor for severe pediatric LRTI. MR-proADM might only bear limited value for decision making on stopping antibiotics due to its slow decrease. Copeptin had no added value in our setting.
Highlights
Lower respiratory tract infection (LRTI) is a leading cause of morbidity and mortality in children and adolescents worldwide [1, 2]
Elevated MR-proADM and increases thereof were associated with intensive care unit (ICU) admission suggesting the potential as a prognostic factor for severe pediatric lower respiratory tract infections (LRTI)
First studies on copeptin in pediatric LRTI demonstrated that copeptin might be used to diagnose community-acquired pneumonia (CAP) and to predict development of complications, but the results of these studies were contradictory [15–19] and kinetics over time have not been assessed yet
Summary
Lower respiratory tract infection (LRTI) is a leading cause of morbidity and mortality in children and adolescents worldwide [1, 2]. Copeptin is a 39-amino acid glycopeptide representing the C-terminal part of the vasopressin precursor molecule pre-provasopressin. First studies on copeptin in pediatric LRTI demonstrated that copeptin might be used to diagnose community-acquired pneumonia (CAP) and to predict development of complications, but the results of these studies were contradictory [15–19] and kinetics over time have not been assessed yet. We aimed at (i) determining the kinetic profiles of copeptin and MR-proADM over five days in children and adolescents admitted to the emergency department for suspected LRTI, and (ii) investigating the influence of clinical and laboratory covariates as well as the development of LRTI complications on copeptin and MR-proADM course over time in a retrospective subanalysis of the ProPAED trial [9]. Kinetics of copeptin and mid regional proadrenomedullin (MR-proADM) during febrile pediatric lower respiratory tract infections (LRTI) are unknown. We aimed to analyze kinetic profiles of copeptin and MR-proADM and the impact of clinical and laboratory factors on those biomarkers
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