Urinary proadrenomedullin predicts severity of community-acquired pneumonia in children

Urinary proadrenomedullin (proADM)/creatinine (Cr) ratio measured at the time of emergency department visit appears predictive of the development of severe outcomes in children with community-acquired pneumonia (CAP), with stronger discriminatory performance in radiographic disease, suggests a recent study.

The investigators conducted this prospective cohort study in 427 children aged 3 months to 18 years with CAP and calculated the urinary proADM/Cr ratio. Logistic regression was used to analyse outcomes within the cohort with suspected CAP and in a subset with radiographic CAP.

Disease severity was defined as mild (discharged home), mild-moderate (hospitalized but not moderate-severe or severe), moderate-severe (eg, hospitalized with supplemental oxygen and complicated pneumonia), and severe (eg, vasopressors and invasive ventilation).

Higher proADM/Cr correlated with a higher likelihood of severe disease compared with nonsevere disease (suspected CAP: odds ratio [OR], 1.02, 95 percent confidence interval [CI], 1.003–1.04; radiographic CAP: OR, 1.03, 95 percent CI, 1.01–1.06) when adjusted for covariates.

The area under the receiver operating characteristic curve for proADM/Cr to differentiate severe from nonsevere disease was 0.56 (threshold, 0.9 pmol/mg) in suspected CAP and 0.65 (threshold, 0.82 pmol/mg) in radiographic CAP.

Of note, healthy controls showed less proADM in their urine (median, 0.61 pmol/mg) than those with suspected (0.87 pmol/mg; p=0.018) and radiographic CAP (0.73 pmol/mg; p=0.016).

“ProADM is a promising biomarker to predict disease severity in CAP,” the investigators said. “Urinary biomarkers offer advantages over blood, including ease of collection.”