Diagnostic and prognostic value of procalcitonin and mid-regional pro-adrenomedullin in septic paediatric patients


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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Fig. 1
Fig. 2



American College of Critical Care Medicine


Acute Physiology and Chronic Health disease Classification System II


Area under the curve


C-reactive protein.


Gram-negative bacilli


Gram-negative cocci


Gram-negative cocci-bacilli


Gram-positive cocci


Intensive care unit


Interquartile ranges




Likelihood ratio


Length of hospitalization




Mid-regional pro-adrenomedullin


Mechanical ventilation






Negative predictive value




Paediatric Logistic Organ Dysfunction Score-2


Paediatric Intensive Care Unit


Positive predictive value


Paediatric Risk of Mortality Score III


paediatric Sequential Organ Failure Assessment


Receiver operating characteristic


Simplified Acute Physiology Score




Sequential Organ Failure Assessment




Time-Resolved Amplified Cryptate Emission


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All authors made substantial contributions to the study:Anna Solé-Ribalta contributed on conceptualization and design, methodology, investigation, data curation and formal analysis; Sara Bobillo-Pérez contributed on investigation, data curation and formal analysisAnna Valls contributed on methodology; Monica Girona-Alarcón contributed on conceptualization and design and investigation; Cristian Launes contributed on methodology and supervision; Francisco José Cambra contributed on investigation and supervision;Iolanda Jordán contributed on conceptualization and design, methodology, formal analysis and supervision;Elisabeth Esteban contributed on investigation formal analysis and supervision.

All authors also participated in the writing and/or revision of the manuscript: Anna Solé-Ribalta, Sara Bobillo-Pérez, Anna Valls, Monica Girona-Alarcon participated in drafting the initial manuscript; Anna Solé-Ribalta, Cristian Launes, Francisco José Cambra, Iolanda Jordan and Elisabeth Esteban participated in review and editing the manuscript.

All authors gave the final approval of the version to be published and agreed to be accountable for all aspects of the work.

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Correspondence to Iolanda Jordan.

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Solé-Ribalta, A., Bobillo-Pérez, S., Valls, A. et al. Diagnostic and prognostic value of procalcitonin and mid-regional pro-adrenomedullin in septic paediatric patients. Eur J Pediatr 179, 1089–1096 (2020). https://doi.org/10.1007/s00431-020-03587-7

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  • Sepsis
  • Adrenomedullin
  • Procalcitonin
  • Paediatric
  • Diagnosis
  • Stratification