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Valeriani E, Falletta A, Pastori D, Porfidia A, Mastroianni CM, Di Bari S, Motta E, Pignatelli P, Oliva A. Midregional-proAdrenomedullin as a prognostic tool in sepsis and septic shock: A systematic review and meta-analysis. Eur J Clin Invest 2024:e14225. [PMID: 38632681 DOI: 10.1111/eci.14225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 03/20/2024] [Accepted: 04/06/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Midregional-proAdrenomedullin (MR-proADM) has been recently proposed as a tool in patients with sepsis and septic shock. Our aim was to evaluate the prognostic role of MR-proADM in hospitalized patients with sepsis and septic shock. METHODS PRISMA guideline was followed. MEDLINE and EMBASE were searched up to June 2023. Primary outcome was mean difference in MR-proADM among survivors and nonsurvivors, secondary outcome mean difference in MR-proADM according to infection severity and type. Risk of bias was evaluated using Newcastle-Ottawa scale for observational studies and Cochrane tool for randomized trials. Pooled mean differences (MD) with corresponding 95% confidence intervals (CIs) were calculated in a random-effects model. RESULTS Twenty-four studies included 6730 adult patients (1208 nonsurvivors and 5522 survivors) and three studies included 195 paediatric patients (30 nonsurvivors and 165 survivors). A total of 10, 4 and 13 studies included, respectively, patients with sepsis (3602 patients), septic shock (386 patients) and a mixed population (2937 patients). Twenty-one studies included patients with different source of infection, three with pneumonia and one with a catheter-related infection. Most studies (n = 12) had a follow-up of 28 days. In adult cohort, pooled mean difference between nonsurvivors and survivors of MR-proADM was 2.55 mmol/L (95% CI: 1.95-3.15) with higher values in patients with septic shock (4.25 mmol/L; 95% CI, 2.23-6.26 mmol/L) than in patients with sepsis (1.77 mmol/L; 95% CI: 1.11-2.44 mmol/L). In paediatric cohort, pooled mean difference was 3.11 mmol/L (95% CI: -0.02-6.24 mmol/L). CONCLUSIONS Higher values of MR-proADM are detectable in nonsurvivors adult and paediatric-hospitalized patients with sepsis or septic shock.
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Affiliation(s)
- Emanuele Valeriani
- Department of General Surgery and Surgical Specialty, Sapienza University of Rome, Rome, Italy
- Department of Infectious disease, Umberto I Hospital, Rome, Italy
| | - Antonio Falletta
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Daniele Pastori
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Angelo Porfidia
- Department of Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli, Rome, Italy
| | | | - Silvia Di Bari
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Eleonora Motta
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Pasquale Pignatelli
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Alessandra Oliva
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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Solé-Ribalta A, Bobillo-Pérez S, Jordan-García I. A Review of Adrenomedullin in Pediatric Patients: A Useful Biomarker. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1181. [PMID: 36010070 PMCID: PMC9406574 DOI: 10.3390/children9081181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 11/18/2022]
Abstract
Adrenomedullin has several properties. It acts as a potent vasodilator, has natriuretic effects, and reduces endothelial permeability. It also plays a role in initiating the early hyperdynamic phase of sepsis. Since its discovery, many articles have been published studying the uses and benefits of this biomarker. The aim of this review is to determine the usefulness of adrenomedullin in pediatric patients. Relevant studies covering adrenomedullin in pediatrics (<18 years) and published up until August 2021 were identified through a search of MEDLINE, PubMed, Embase, Web of Science, Scopus, and Cochrane. Seventy studies were included in the present review, most of them with a low level of evidence (IV to VI). Research on adrenomedullin has primarily been related to infection and the cardiovascular field. The performance of adrenomedullin to quantify infection in children seems satisfactory, especially in sepsis. In congenital heart disease, this biomarker seems to be a useful indicator before, during, and after cardiopulmonary bypass. Adrenomedullin seems to be useful in the pediatric population for a large variety of pathologies, especially regarding infection and cardiovascular conditions. However, it should be used in combination with other biomarkers and clinical or analytical variables, rather than as a single tool.
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Affiliation(s)
| | | | - Iolanda Jordan-García
- Pediatric Intensive Care Unit Service, Hospital Sant Joan de Déu, 08950 Esplugues de Llobregat, Barcelona, Spain
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3
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Corr MP, Fairley D, McKenna JP, Shields MD, Waterfield T. Diagnostic value of mid-regional pro-Adrenomedullin as a biomarker of invasive bacterial infection in children: a systematic review. BMC Pediatr 2022; 22:176. [PMID: 35379203 PMCID: PMC8977188 DOI: 10.1186/s12887-022-03255-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background Invasive bacterial infections (IBI) in children present a difficult clinical challenge. They are often life-threatening, however in the early stages they can be hard to differentiate from benign viral infections. This leaves clinicians with the risk of missing a serious IBI diagnosis or inappropriately using antimicrobials in a child with a viral infection- contributing to the ongoing development of increased antimicrobial resistance. Hence, biomarkers which could aid in early detection of IBI and differentiation from viral infections are desirable. Mid-Regional pro-Adrenomedullin (MR-proADM) is a biomarker which has been associated with IBI. The aim of this systematic review was to determine its diagnostic accuracy in identifying children with IBI. Methods A strategy was devised to search online databases MEDLINE, Embase, Web of Science and Scopus for human clinical trials reporting the accuracy of MR-proADM in children. Against predesigned inclusion and exclusion criteria full texts were selected for inclusion and data extraction. True positives, false positives, true negatives and false negatives were extracted from each included study to fill 2 × 2 tables. Using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool methodological quality of each study was assessed. Results A total of 501 articles were initially identified. After the removal of duplicates and abstract screening 11 texts were fully reviewed and four texts (totaling 1404 patients) were included in the systematic analysis. Only one study was of a high quality and that study accounted for the vast majority of patients. A single study reported the diagnostic accuracy of MR-proADM for invasive bacterial infection reporting an Area under the Curve of 0.69. The paucity of available studies made meta-analysis and studies of heterogeneity impossible. Conclusion There is a paucity of research regarding the diagnostic accuracy of MR-proADM in the diagnosis of invasive bacterial infections in children. Initial results would suggest that MR-proADM testing alone is poor at identifying IBI in young children. It remains unclear if MR-proADM performs differently in older children or in children with signs and symptoms of IBI. Trial registration PROSPERO CRD42018096295. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03255-9.
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Affiliation(s)
| | - Derek Fairley
- Department of Microbiology, Belfast Health and Social Care Trust, Belfast, UK
| | - James P McKenna
- Department of Microbiology, Belfast Health and Social Care Trust, Belfast, UK
| | - Michael D Shields
- Centre for Experimental Medicine, Wellcome Wolfson Institute of Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Thomas Waterfield
- Centre for Experimental Medicine, Wellcome Wolfson Institute of Experimental Medicine, Queen's University Belfast, Belfast, UK
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Z Oikonomakou M, Gkentzi D, Gogos C, Akinosoglou K. Biomarkers in pediatric sepsis: a review of recent literature. Biomark Med 2020; 14:895-917. [PMID: 32808806 DOI: 10.2217/bmm-2020-0016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 05/12/2020] [Indexed: 01/10/2023] Open
Abstract
Sepsis remains the leading cause of death in infants and children worldwide. Prompt diagnosis and monitoring of infection is pivotal to guide therapy and optimize outcomes. No single biomarker has so far been identified to accurately diagnose sepsis, monitor response and predict severity. We aimed to assess existing evidence of available sepsis biomarkers, and their utility in pediatric population. C-reactive protein and procalcitonin remain the most extensively evaluated and used biomarkers. However, biomarkers related to endothelial damage, vasodilation, oxidative stress, cytokines/chemokines and cell bioproducts have also been identified, often with regard to the site of infection and etiologic pathogen; still, with controversial utility. A multi-biomarker model driven by genomic tools could establish a personalized approach in future disease management.
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Affiliation(s)
| | - Despoina Gkentzi
- Department of Pediatrics, University Hospital of Patras, Rio 26504, Greece
| | - Charalambos Gogos
- Department of Internal Medicine & Infectious Diseases, University Hospital of Patras, Rio 26504, Greece
| | - Karolina Akinosoglou
- Department of Internal Medicine & Infectious Diseases, University Hospital of Patras, Rio 26504, Greece
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5
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Diagnostic and prognostic value of procalcitonin and mid-regional pro-adrenomedullin in septic paediatric patients. Eur J Pediatr 2020; 179:1089-1096. [PMID: 31974673 DOI: 10.1007/s00431-020-03587-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 01/16/2020] [Accepted: 01/17/2020] [Indexed: 10/25/2022]
Abstract
Early diagnosis of sepsis and its severity stratification at admission is critical to improve patient outcomes and to ensure the optimal use of health care resources. In order to assess the diagnostic potential of mid-regional pro-adrenomedullin (MR-proADM) in septic paediatric patients in comparison with procalcitonin (PCT), and to evaluate the usefulness of a single early determination of MR-proADM as a stratification and severity prediction tool, a prospective observational study was conducted. Seventy-three paediatric patients with a suspicion of sepsis were included. A single blood test was carried out at initial time to analyse infection biomarkers. PCT values were significantly higher in septic patients in comparison with non-septic patients (p = 0.03) with an AUC of 0.748 (p = 0.003). Levels of MR-proADM significantly increased in patients with severe sepsis (p = 0.048), with an AUC of 0.729 (p = 0.013). MR-proADM showed a positive correlation with pSOFA, PRISM III, and PELOD-2 severity scores. Levels of MR-proADM were significantly higher in patients who required vasoactive drugs (p = 0.02) or presented renal dysfunction (p = 0.004).Conclusion: PCT appeared to be superior to MR-proADM in diagnosing sepsis. Determining MR-proADM plasma levels at the initial phase of sepsis could be a useful tool for sepsis stratification and morbidity prediction before organ failure occurs. The present results need to be assessed with larger sample size studies.What is Known:•CRP and PCT are already included in clinical practice to assess sepsis and estimate disease severity, although their sensitivity and specificity are lower than desired.•ADM is a protein that has immune and vascular modulation actions, and its blood levels are increased in adult and paediatric sepsis.•ADM is a promising tool for early diagnosis and prognostic assessment in adult sepsis.What is New:•PCT appeared to be superior to MR-proADM in diagnosing paediatric sepsis.•MR-proADM plasma levels could be a useful tool for paediatric sepsis stratification and morbidity prediction.
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Corr M, Waterfield T, Fairley D, McKenna J, Shields MD. A protocol for a systematic review and meta-analysis of the diagnostic accuracy of mid-regional pro-adrenomedullin in predicting invasive bacterial infection in children. Syst Rev 2020; 9:69. [PMID: 32241288 PMCID: PMC7119004 DOI: 10.1186/s13643-020-01338-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 03/19/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The early recognition of invasive bacterial infections (IBI) in children can be difficult. Clinically it is often challenging to differentiate between the early stages of an IBI and a benign self-limiting viral infection. These challenges mandate a cautious approach resulting in the overuse of antimicrobial drugs with resultant antimicrobial resistance. Due to these challenges, there is growing research into the role of biomarkers for the early identification of children with IBI. Earlier and more accurate diagnoses may lead to improved clinical outcomes for children and reduced antimicrobial resistance. Mid-regional pro-adrenomedullin (MR-proADM) is a biomarker that has been shown to be elevated in patients with IBI. The aim of this systematic review is to determine the diagnostic accuracy of MR-proADM at identifying children with IBI. METHODS To identify relevant studies we will search MEDLINE, Embase, Web of Science and Scopus from 1980 to the present day for all human clinical trials involving children that report the test accuracy of MR-proADM. We will include case-control studies, cohort studies and randomised control trials reported in any language. In addition, we will hand-search reference lists and grey literature including conference abstracts and web searches. Two reviewers will independently screen study titles and abstracts for eligibility followed by full-text assessment and data extraction including population, setting, timing and use of index test and reference standard used. Methodological quality will be assessed, by two authors, according to the revised tool for the quality assessment of diagnostic accuracy studies (QUADAS-2), any discrepancies will be resolved by a third author. The following test characteristics will be extracted into 2 × 2 tables for all included studies: true positives, false positives, true negatives and false negatives. Study-specific estimates of sensitivity and specificity with 95% confidence intervals will be displayed in forest plots. DISCUSSION This review will report the normal ranges for MR-proADM in health and the diagnostic accuracy of MR-proADM at identifying children with IBI. The review will help to define where in the diagnostic pathway MR-proADM could be useful including potential as a point-of-care test for children at first presentation with IBI. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018096295.
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Affiliation(s)
- Michael Corr
- Centre for Experimental Medicine, Wellcome Wolfson Institute of Experimental Medicine, Queen’s University Belfast, 97 Lisburn Road, Belfast, BT9 7AE UK
| | - Thomas Waterfield
- Centre for Experimental Medicine, Wellcome Wolfson Institute of Experimental Medicine, Queen’s University Belfast, 97 Lisburn Road, Belfast, BT9 7AE UK
| | | | | | - Michael D. Shields
- Centre for Experimental Medicine, Wellcome Wolfson Institute of Experimental Medicine, Queen’s University Belfast, 97 Lisburn Road, Belfast, BT9 7AE UK
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El Haddad H, Chaftari AM, Hachem R, Chaftari P, Raad II. Biomarkers of Sepsis and Bloodstream Infections: The Role of Procalcitonin and Proadrenomedullin With Emphasis in Patients With Cancer. Clin Infect Dis 2019; 67:971-977. [PMID: 29668936 DOI: 10.1093/cid/ciy331] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 04/12/2018] [Indexed: 12/22/2022] Open
Abstract
Sepsis and bloodstream infections remain a leading cause of death in immunocompromised patients with cancer. The management of these serious infections consist of empiric use of antimicrobial agents which are often overused. Procalcitonin and proadrenomedullin are biomarkers that have been extensively evaluated in the general populations but with little emphasis in the population immunocompromised patients with cancer, where they may have promising roles in the management of febrile patients. In this review, we summarize the available evidence of the potential role of these available biomarkers in guiding antimicrobial therapy to optimize the use of resources in the general patient population. Special emphasis is given to the role of these 2 biomarkers in the immunocompromised and critically ill patients with cancer, highlighting the distinctive utility of each.
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Affiliation(s)
- Hanine El Haddad
- Section of Infectious Diseases, Baylor College of Medicine.,Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston
| | - Anne-Marie Chaftari
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston
| | - Ray Hachem
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston
| | - Patrick Chaftari
- Department of Emergency Medicine, The University of Texas M. D. Anderson Cancer Center, Houston
| | - Issam I Raad
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston
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8
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The Role of Pro-Adrenomedullin as a Marker of Severe Bacterial Infection in Children: A Review. REPORTS 2019. [DOI: 10.3390/reports2030017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Sepsis is still related to high mortality and hospitalization rates in the paediatric population despite medical progress. Prompt recognition of sepsis and consequent initiation of an appropriate treatment are essential elements in securing a positive outcome in adults and children. In such scenario, various biomarkers have been studied to support the clinician in the diagnosis of severe infections, in the identification of patients at risk of progression towards sepsis as well as in the evaluation of the response to treatment. In children, the performance of C-reactive protein and procalcitonin has been largely investigated, whereas data on newer biomarkers of sepsis are scant. The aim of the present review is to summarise the available data on the use of pro-adrenomedullin in the paediatric age.
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9
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Bobillo-Perez S, Jordan I, Corniero P, Balaguer M, Sole-Ribalta A, Esteban ME, Esteban E, Cambra FJ. Prognostic value of biomarkers after cardiopulmonary bypass in pediatrics: The prospective PANCAP study. PLoS One 2019; 14:e0215690. [PMID: 31206538 PMCID: PMC6576774 DOI: 10.1371/journal.pone.0215690] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 04/05/2019] [Indexed: 01/03/2023] Open
Abstract
Objective To assess the usefulness of procalcitonin, pro-adrenomedullin and pro-atrial natriuretic peptide as predictors of need for mechanical ventilation and postoperative complications (need for inotropic support and bacterial infection) in critically ill pediatric patients after cardiopulmonary bypass. Design A prospective, observational study Setting Pediatric intensive care unit. Patients Patients under 18 years old admitted after cardiopulmonary bypass. Measuraments and main results Serum levels of procalcitonin, pro-adrenomedullin and pro-atrial natriuretic peptide were determined immediately after bypass and at 24–36 hours. Their values were correlated with the need for mechanical ventilation, inotropic support and bacterial infection. One hundred eleven patients were recruited. Septal defects (30.6%) and cardiac valve disease (17.1%) were the most frequent pathologies. 40.7% required mechanical ventilation, 94.6% inotropic support and 15.3% presented invasive bacterial infections. Pro-adrenomedullin and pro-atrial natriuretic peptide showed significant high values in patients needing mechanical ventilation. Cut-off values higher than 1.22 nmol/L and 215.3 pmol/L, respectively for each biomarker, may indicate need for mechanical ventilation with an AUC of 0.721 and 0.746 at admission and 0.738 and 0.753 at 24–36 hours, respectively but without statistical differences. Pro-adrenomedullin and procalcitonin showed statistically significant high values in patients with bacterial infections. Conclusions After bypass, pro-adrenomedullin and pro-atrial natriuretic peptide are suitable biomarkers to predict the need for mechanical ventilation. Physicians should be alert if the values of these markers are high so as not to progress to early extubation. Procalcitonin is useful for predicting bacterial infection. This is a preliminary study and more clinical studies should be done to confirm the value of pro-adrenomedullin and pro-atrial natriuretic peptide as biomarkers after cardiopulmonary bypass.
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Affiliation(s)
- Sara Bobillo-Perez
- Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Pediatric Intensive Care Research Group, Institut Recerca Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Iolanda Jordan
- Pediatric Intensive Care Unit, Sant Joan de Déu Hospital, Pediatric Intensive Care Research Group, Institut Recerca Hospital Sant Joan de Déu, CIBERESP, Barcelona, Spain
- * E-mail:
| | - Patricia Corniero
- Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Monica Balaguer
- Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Anna Sole-Ribalta
- Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Maria Esther Esteban
- Section of Zoology and Biological Anthropology, Department of Evolutionary Biology, Ecology and Environmental Sciences, Faculty of Biology, Universitat de Barcelona, Barcelona, Spain
- Institut de Recerca de la Biodiversitat (IRBio), Universitat de Barcelona, Barcelona, Spain
| | - Elisabeth Esteban
- Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Barcelona, Spain
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Li X, Yan B. Research on the effect of cytokine concentration on the immune level and survival conditions of elderly patients with sepsis. Exp Ther Med 2018; 16:842-846. [PMID: 30112039 PMCID: PMC6090424 DOI: 10.3892/etm.2018.6221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 05/17/2018] [Indexed: 11/22/2022] Open
Abstract
The present study was carried out to investigate the effect of cytokine (CK) concentrations on the immune phenotype and survival conditions of elderly patients with sepsis. A total of 112 elderly patients with sepsis who were admitted to The Affiliated Hospital of Medical School, Ningbo University for treatment between June 2015 and June 2017 were enrolled as the subjects. According to each patient's condition, they were divided into the mild sepsis group (n=68) and the severe sepsis group (n=44). Additionally, a further 60 patients without sepsis who were admitted to the Intensive Care Unit (ICU) of this hospital during the same period were recruited as the control group. The levels of CK, tumor necrosis factor α (TNF-α), interleukin (IL)-6, IL-8, procalcitonin (PCT), endothelin-1 (ET-1) and IL-10 were detected, and the assessment system for immune levels was established. The levels of TNF-α, IL-6, IL-8, PCT, ET-1 and IL-10 in the serum of patients in the mild and severe sepsis groups were significantly higher than those in the control group (P<0.05), and the levels in the severe sepsis group were significantly higher than those in the mild sepsis group (P<0.05). Among the 112 sepsis patients, there were 30 mortalities (26.79%) within 30 days, of which the levels of TNF-α, IL-6, IL-8, PCT, ET-1 and IL-10 were significantly higher than those in the surviving patients (P<0.05). Between the mild and severe sepsis groups, as well as the number of mortalities and surviving patients, there were statistically significant differences when comparing the immunological phenotypes (P<0.05). These findings indicated that the levels of TNF-α, IL-6, IL-8, PCT, ET-1 and IL-10 were associated with the condition and prognosis of elderly patients with sepsis, and the assessment system for immune levels based on the levels of these indicators was conducive to the stipulation of individualized immune regulation procedure and prognostic evaluation of sepsis.
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Affiliation(s)
- Xuguang Li
- ICU, The Affiliated Hospital of Medical School, Ningbo University, Ningbo, Zhejiang 315000, P.R. China
| | - Biqing Yan
- ICU, The Affiliated Hospital of Medical School, Ningbo University, Ningbo, Zhejiang 315000, P.R. China
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11
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Fischer JP, Els-Heindl S, Schönauer R, Bierer D, Köbberling J, Riedl B, Beck-Sickinger AG. The Impact of Adrenomedullin Thr22 on Selectivity within the Calcitonin Receptor-like Receptor/Receptor Activity-Modifying Protein System. ChemMedChem 2018; 13:1797-1805. [DOI: 10.1002/cmdc.201800329] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 06/26/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Jan-Patrick Fischer
- Institute of Biochemistry; Leipzig University; Brüderstraße 34 04103 Leipzig Germany
| | - Sylvia Els-Heindl
- Institute of Biochemistry; Leipzig University; Brüderstraße 34 04103 Leipzig Germany
| | - Ria Schönauer
- Institute of Biochemistry; Leipzig University; Brüderstraße 34 04103 Leipzig Germany
| | - Donald Bierer
- Department of Medicinal Chemistry; Bayer AG; Aprather Weg 18 A 42096 Wuppertal Germany
| | - Johannes Köbberling
- Department of Medicinal Chemistry; Bayer AG; Aprather Weg 18 A 42096 Wuppertal Germany
| | - Bernd Riedl
- Department of Medicinal Chemistry; Bayer AG; Aprather Weg 18 A 42096 Wuppertal Germany
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Lanziotti VS, Póvoa P, Soares M, Silva JRLE, Barbosa AP, Salluh JIF. Use of biomarkers in pediatric sepsis: literature review. Rev Bras Ter Intensiva 2017; 28:472-482. [PMID: 28099644 PMCID: PMC5225923 DOI: 10.5935/0103-507x.20160080] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 08/09/2016] [Indexed: 12/17/2022] Open
Abstract
Despite advances in recent years, sepsis is still a leading cause of
hospitalization and mortality in infants and children. The presence of
biomarkers during the response to an infectious insult makes it possible to use
such biomarkers in screening, diagnosis, prognosis (risk stratification),
monitoring of therapeutic response, and rational use of antibiotics (for
example, the determination of adequate treatment length). Studies of biomarkers
in sepsis in children are still relatively scarce. This review addresses the use
of biomarkers in sepsis in pediatric patients with emphasis on C-reactive
protein, procalcitonin, interleukins 6, 8, and 18, human neutrophil gelatinase,
and proadrenomedullin. Assessment of these biomarkers may be useful in the
management of pediatric sepsis.
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Affiliation(s)
- Vanessa Soares Lanziotti
- Instituto D'Or de Pesquisa e Ensino - Rio de Janeiro (RJ), Brasil.,Universidade Federal do Rio de Janeiro - Rio de Janeiro (RJ), Brasil
| | - Pedro Póvoa
- NOVA Medical School, Universidade Nova de Lisboa - Lisboa, Portugal.,Unidade de Cuidados Intensivos Polivalente, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental - Lisboa, Portugal
| | - Márcio Soares
- Instituto D'Or de Pesquisa e Ensino - Rio de Janeiro (RJ), Brasil
| | | | - Arnaldo Prata Barbosa
- Instituto D'Or de Pesquisa e Ensino - Rio de Janeiro (RJ), Brasil.,Unidade de Cuidados Intensivos Polivalente, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental - Lisboa, Portugal
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13
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Asociación de valores elevados de péptido natriurético auricular y copeptina con riesgo de mortalidad. An Pediatr (Barc) 2016; 85:284-290. [DOI: 10.1016/j.anpedi.2016.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 02/02/2016] [Accepted: 02/03/2016] [Indexed: 11/22/2022] Open
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14
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Rey C, García-Cendón C, Martínez-Camblor P, López-Herce J, Concha-Torre A, Medina A, Vivanco-Allende A, Mayordomo-Colunga J. High levels of atrial natriuretic peptide and copeptin and mortality risk. An Pediatr (Barc) 2016. [DOI: 10.1016/j.anpede.2016.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Simon TP, Martin L, Doemming S, Humbs A, Bruells C, Kopp R, Hartmann O, Struck J, Bergmann A, Marx G, Schuerholz T. Plasma adrenomedullin in critically ill patients with sepsis after major surgery: A pilot study. J Crit Care 2016; 38:68-72. [PMID: 27865148 DOI: 10.1016/j.jcrc.2016.10.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 07/30/2016] [Accepted: 10/21/2016] [Indexed: 11/18/2022]
Abstract
PURPOSE Adrenomedullin is released by different tissues in hypoxia, oxidative stress, and inflammation and is found in general and medical patients and, recently, in sepsis patients in emergency departments. The aim of this study was to evaluate biologically active adrenomedullin that mirrors directly the active peptide levels in plasma of surgical intensive care unit (ICU) patients with sepsis. MATERIALS AND METHODS In this single-center observational pilot trial, 42 ICU patients with sepsis and 14 patients after major surgery were included after sepsis diagnosis or ICU admission. RESULTS Patients (66% male) were 70 (median) (interquartile range [IQR], 61-77]) years old and had a body mass index of 26.2 (24.2-29.4) kg/m2. The ICU and hospital length of stay was 8 (1-22) and 17 (8-21) days, respectively. Eight patients had sepsis, 19 developed severe sepsis, and 15 suffered from septic shock. Adrenomedullin increased with severity (sepsis: 25.8 pg/mL [IQR 20.3-40.2], severe sepsis: 84.2 pg/mL [IQR 42.7-118.5], septic shock: 119.7 pg/mL [IQR 83.8-172.6]; P<.0001). Higher adrenomedullin was associated with poor 90-day outcomes (P=.019) and more frequent vasopressor use (P=.001). CONCLUSIONS This is the first study investigating adrenomedullin in patients with sepsis following major surgery. Higher adrenomedullin on admission is associated with increased vasopressor need and mortality after 90 days. Thus, adrenomedullin may be a useful additional parameter in surgical patients with sepsis.
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Affiliation(s)
- Tim-Philipp Simon
- Department of Intensive Care and Intermediate Care, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Lukas Martin
- Department of Intensive Care and Intermediate Care, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Sabine Doemming
- Department of Intensive Care and Intermediate Care, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Andreas Humbs
- Department of Intensive Care and Intermediate Care, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Christian Bruells
- Department of Intensive Care and Intermediate Care, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Ruedger Kopp
- Department of Intensive Care and Intermediate Care, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Oliver Hartmann
- Sphingotec GmbH, Neuendorfstraße 15A, 16761, Hennigsdorf, Germany
| | - Joachim Struck
- Sphingotec GmbH, Neuendorfstraße 15A, 16761, Hennigsdorf, Germany
| | - Andreas Bergmann
- Sphingotec GmbH, Neuendorfstraße 15A, 16761, Hennigsdorf, Germany
| | - Gernot Marx
- Department of Intensive Care and Intermediate Care, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Tobias Schuerholz
- Department of Intensive Care and Intermediate Care, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Germany.
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White K, Gaudieri S. New hope for biomarkers in the practice of infectious diseases medicine. Biomark Med 2015; 8:1049-51. [PMID: 25402573 DOI: 10.2217/bmm.14.94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Katie White
- Division of Infectious Diseases, Vanderbilt University, Nashville, TN, USA
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