679. Use of Soluble Triggering Receptor Expressed on Myeloid Cells-1 (sTREM-1), Midregional Proadrenomedullin (MR-proADM) and Midregional Proatrial Natriuretic Peptide (MR-proANP) for Identification of Etiology and Assessment of Severity of Community-Acquired Pneumonia (CAP) in Children
Session: Poster Abstract Session: They've Been Here a Billion Years! Pediatric Bacterial and Viral Infections
Thursday, October 27, 2016
Room: Poster Hall
  • Poster CAP IDWeek Finale 13 10 16.pdf (584.5 kB)
  • Background: Knowledge of etiology and severity of disease is essential in order to guide treatment decisions in patients with CAP. In children, even more than in adults, achievement of these objectives is difficult for the poor cooperation of the patient. Moreover, signs and symptoms, radiological findings and routine laboratory tests are poorly effective in these aims. Data collected in adults suggest that sTREM-1, MR-proADM, and MR-proANP evaluation might be effective in defining etiology and severity of CAP. This study analysed the role of these biomarkers in children.

    Methods: In 433 children hospitalized for radiographically-confirmed CAP, 312 (72.2%) of whom had severe disease, together with routine determination of white blood cell (WBC) count, C reactive protein (CRP), and procalcitonin (PCT), sTREM-1, MR-proADM, and MR-proANP were tested on admission. Differentiation of viral from bacterial cases was made combining radiological findings (i.e., alveolar or non-alveolar CAP) with detection of respiratory viruses and bacteria in blood and respiratory secretions. Results were analyzed using area under receiver-operator characteristic curves (AUC) to assess the overall discriminatory power of biomarkers in predicting etiology and severity.

    Results: A total of 235 (54.3%) children with bacterial and 111 (25.6%) with viral CAP were identified. All the studied biomarkers had poor ability to differentiate etiology and severity of CAP. However, PCT and CRP were the best predictors of etiology and PCT and MR-proANP the best predictor of severity. For bacterial CAP, AUC were 0.69, 0.66 and 0.52 for PCT, CRP and WBC and 0.50, 0.52, and 0.58 for sTREM-1, MR-proANP, and MR-proADM, respectively. For viral CAP, AUC for PCT and CRP were 0.67 and 0.68, whereas those for all the other studied markers remained between 0.51 and 0.56. Finally, AUC for CAP severity were 0.65 for both PCT and MR-proANP and under 0.60 for all the other biomarkers. Combination of different biomarkers did not increase AUC values.

    Conclusion: Evaluation of serum sTREM-1, MR-proADM, and MR-proANP does not solve the problem of the definition of etiology and severity of pediatric CAP. PCT, despite suboptimal, offers the best contribution in these evaluations in order to optimize antibiotic therapy.

    Susanna Esposito, MD, Pediatric Highly Intensive Care Unit, Univ Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy, Nicola Principi, MD, Pediatric Highly Intensive Care Unit, Univ Milan, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy and Ita-CAP Study Group


    S. Esposito, None

    N. Principi, None

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