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Objective:To explore the value of body temperature, pediatric clinical illness score(PCIS), white blood cell count (WBC), plasma C-reactive protein (CRP), procalcitonin (PCT) and pro-adrenomedullin (pro-ADM) in predicting nosocomial infection in PICU.Methods:From June 2016 to March 2017, the critically ill children in PICU of Children′s Hospital of Fudan University were selected and divided into nosocomial infection group and non nosocomial infection group according to the diagnostic criteria of nosocomial infection.The body temperature, PCIS, WBC, CRP, PCT and pro-ADM were recorded at 4 hours (T1), (48±1) hours (T2), (120±1) hours (T3) and (192±1) hours (T4) after admission, and their predictive value of each index, which was the closest time point (Th) to nosocomial infection was analyzed.Receiver-operating characteristic (ROC) curves were performed to calculate the areas under the curves (AUC), sensitivity and specificity, and multivariate Logistic regression analysis was used to study the risk factors of nosocomial infection.Results:A total of 85 cases were included, including 27 cases in nosocomial infection group and 58 cases in non nosocomial infection group.There was no significant difference in age, weight, body temperature, WBC, PCT, pro-ADM, primary disease and invasive operation between two groups (all P>0.05). There were significant differences in gender, PCIS, CRP, intubation rate and central venous catheterization rate ( P<0.05), when patients were admitted to PICU.At Th, the differences of body temperature, PCIS, CRP, PCT and pro-ADM between two groups were statistically significant ( P<0.05), as well as the AUC were 0.787, 0.755, 0.709, 0.704 and 0.809, respectively, as well as the best cut-off values for predicting nosocomial infection were 38.0 ℃, 87 points, 14.5 mg/L, 0.28 ng/mL and 0.67 nmol/L, respectively.There was no significant difference regarding WBC between two groups ( P>0.05). PCIS may be an independent risk factor for nosocomial infection( OR=0.978, 95% CI 95.9-99.9, P<0.05). Conclusion:Pro-ADM has high sensitivity and specificity in predicting nosocomial infection, and PCIS is an independent risk factor for nosocomial infection.
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Objective To study the change of mid-regional pro-adrenomedullin(MR-proADM) level in patients with chronic heart failure and its significance.Methods Randomly selected 330 patients with chronic heart failure,including 120 cases of grade Ⅱ and Ⅲ,90 cases of grade Ⅳ,90 cases were selected.,Within 24 h after the entry of the group and 7 d after symptom relieved,serum N-terminal pro-B-type natriuretic peptide(NT-proBNP),MR-proADM,cardiac ultrasound(left ventricular diameter(LVEDD) and left ventricular function(LVEF)) were measured.Ninety physical examination in the same period as healthy control during the same period.The change of MR-proADM level in patients with chronic heart failure and its significance were analyze.Results Compared with the healthy control group,the level of MR-proADM in patients with chronic heart failure(grade Ⅱ:(641.55±106.34) pmol/l;grade Ⅲ:(684.46±101.33) pmol/l;grade Ⅳ:(737.81±479.37) pmol/l) was significantly higher than that in the control group(610.22±60.84) pmol/l),the difference was statistically significant(F=5.33,P=0.001).At the same time,the level of MR-proADM was increased with the aggravation of heart failure,after drug treatment will decline((608.09±100.81),(617.64±94.32),(642.22±163.53) pmol/L).And MR-proADM levels were significantly positively correlated with NT-proBNP levels and NYHA classification in patients with heart failure(r=0.194,P=0.003;r=0.206,P=0.000).Conclusion MR-proADM has important guiding significance in the diagnosis,classification of patients with chronic heart failure.
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Objective To explore the relationship between preoperative serum pro-adrenomedullin (pro-ADM) in the patients with closed rupture of small intestine,and postoperative secondary abdominal infection,and to study the value of postoperative serum pro-ADM in assessment of severity of postoperative secondary abdominal infection of this patients.Methods Eighty-five patients with closed rupture of small intestine treated in the emergency surgery from June 2014 to May 2015 were selected.According to the presence of postoperative abdominal infection or not,these patients were divided into infection group and non-infection group.The infection group was further divided into SIRS,sepsis,severe sepsis,septic shock subgroups as per the severity of infection.The levels of serum pro-ADM,interleukin-6 (IL-6),C-reactive protein (CRP) were determined and the acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score was calculated at admission and the first day、the second day and the third day after operation.Comparisons of these biomarkers were carried out to find out the factors associated with postoperative abdominal infection.In addition,ROC curve was used to verify the factors for predicting the abdominal infection of these patients after operation.The relationship between serum levels of pro-ADM and APACHE Ⅱ score after operation was analyzed.The severity of abdominal infection after operation was assessed with laboratory findings.Results Compared with non-infection group,preoperative and postoperative serum pro-ADM (P =0.03,P ＜ 0.01),IL-6 (P =0.02,P ＜0.01) levels and APACHE Ⅱ scores (P ＜ 0.01,P ＜ 0.01) were significantly higher in infection group (P ＜ 0.05).In the infection groups,the postoperative levels of serum pro-ADM and APACHE Ⅱ scores were increased with the severity of infection increased (r =0.924),and the difference between the groups was statistically significant (P ＜ 0.05),but there were no significant differences in IL-6 and CRP levels between two groups.Conclusion (1) The serum levels of pro-ADM before operation has value in predicting the genesis of abdominal infection in these patients after operation.(2) The serum levels of pro-ADM after operation has value in severity assessment of abdominal infection in these patients after operation.
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ObjectiveTo explore the early diagnostic value of pro-adrenomedullin (pro-ADM) in sepsis. Methods A prospective study was conducted. Eighty-two patients with acute infection admitted to Department of Emergency of Shanxi Medical University Second Hospital from April 2013 to March 2014 were enrolled. According to the diagnostic criteria of sepsis, the patients with acute infection were divided into ordinary infection group [infection without systemic inflammatory response syndrome (SIRS),n = 25] and sepsis group (infection combined with SIRS, n = 57). According to degree of severity of sepsis, the latter group was subdivided into three subgroups: sepsis group (n = 22), severe sepsis group (n = 27) and septic shock group (n = 8). Twenty-four healthy persons were included to serve as healthy control group. The venous blood from all the research objects in hospital was collected within 24 hours. The levels of pro-ADM and procalcitonin ( PCT ) were determined by enzyme linked immunosorbent assay (ELISA), and acute physiology and chronic health evaluationⅡ (APACHEⅡ) score was recorded. The relationship between pro-ADM and PCT and also APACHEⅡ score was analyzed with Pearson correlation analysis. The receiver-operating characteristic curve (ROC) of pro-ADM and PCT were used to evaluate the diagnostic acuity of sepsis.Results The plasma levels of pro-ADM, PCT and APACHEⅡ score in sepsis group were significantly higher than those in ordinary infection group and healthy control group [pro-ADM (ng/L): 66.69±1.73 vs. 53.43±2.70, 45.87±1.43; PCT (ng/L):1 336.49±40.26 vs. 1 083.09±47.99, 959.04±37.53; APACHEⅡ score: 14.60±0.81 vs. 8.10±1.14, 3.00±1.15,allP< 0.01]. With the aggravation of sepsis, the levels of pro-ADM, PCT and APACHEⅡ score were gradually increased, and there were significant differences among sepsis, severe sepsis, and septic shock groups [pro-ADM (ng/L): 64.91±2.50, 73.56±2.80, 84.67±4.52; PCT (ng/L): 1 152.65±48.62, 1 233.93±63.06, 1 475.71±109.93;APACHEⅡ score: 12.91±1.15, 14.55±1.14, 19.37±2.40,P< 0.05 orP< 0.01]. Pearson correlation analysis results showed that the level of pro-ADM was positively related with PCT (r = 0.473,P = 0.006), and it was also positively correlated with APACHEⅡ score (r = 0.707,P = 0.008). ROC curve analysis showed that area under the ROC curve (AUC) of pro-ADM for diagnosis of sepsis was 0.823 (P = 0.003). When the cutoff value was 59.40 ng/L, the sensitivity was 80.7%, the specificity was 68.0%, the positive predictive value was 85.2%, and the negative predictive value was 60.7%. AUC of the PCT for diagnosis of sepsis was 0.653 (P = 0.043). When the cutoff value was 1 194.67 ng/L, the sensitivity was 68.4%, the specificity was 64.0%, the positive predictive value was 81.8%, and the negative predictive value was 44.7%. It was proved that the pro-ADM had a higher diagnostic value for sepsis than PCT.Conclusion The plasma levels of pro-ADM can be used as an early indicator in diagnosis and severity evaluation and prognosis in patients with sepsis .
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The aim of this study was to clarify the prognostic value of serum pro- Adrenomedullin level (pro-ADM) and Anti thrombin level in neonatal sepsis. 40 term neonates with sepsis were enrolled in this study including 20 cases with mild sepsis and 20 cases with severe sepsis. Twenty healthy matched neonates served as a control group. Serum levels of Pro ADM and Antithrombin were measured in all patients and the control group. Serum Pro ADM level was higher in neonates with sepsis than control group, higher in severe than mild sepsis, and was higher in non survivors. Antithrombin concentrations were lower in sepsis cases than control, lower in severe than mild sepsis, and lower in non-survivors.
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There are numerous complex mechanisms contributing to the evolution of septic shock, and early diagnosis and intervention will improve the prognosis of patient with septic shock. Recently plasma concentrations of some bio-markers like pro-ADM,pro-ANP,pro-ET1 and copeptin are found increasing in patient with septic shock.The plasma concentrations of these bio-markers are positively related with the severity of infection.These bio-markers have long halflife and are easily assayed. They may be the new bio-markers for the early diagnosis of septic shock.
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Aim To study the effect of Peptide fragments that originate from the same proadrenomedullin on cAMP in rat aorta.Methods Isolated aortic tissues were exposed to ADM,PAMP and ADT for 2 h.The content of cAMP in the incubated media was assayed by radioimmunoassay.Results ① The content of cAMP in the aortic tissues that were exposed to ADM (10~(-7) and 10~(-8) mol·L~(-1)) was significantly increased. The content of cAMP in the aortic tissues stimulated by PAMP (10~(-8) mol·L~(-1))or ADT (10~(-8) mol·L~(-1))alone was significantly increased, compared with the control.② The content of cAMP was not in-creased when the tissues were treated with ADM (10~(-8) mol·L~(-1)) and PAMP (10~(-8) mol·L~(-1)) or ADT (10~(-8) mol·L~(-1)) in combination, compared with that after the treatment with ADM(10~(-8) mol·L~(-1))alone, but was significantly decreased than that in PAMP(10~(-8) mol·L~(-1)) or ADT(10~(-8)mol·L~(-1)) groups. After incubation with ADM,PAMP and ADT at the same dose (10~(-8) mol·L~(-1)), the content of cAMP did not change as compared with that of the ADM group (10~(-8) mol·L~(-1),P>0.05), but was greatly reduced, compared with that of the PAMP or ADT groups(10~(-8) mol·L~(-1),P<0.01).Conclusion ADM, PAMP and ADT which originate from the proadrenomedullin have an antagonism on cAMP production in rat aorta.
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0.05),but was greatly reduced,compared with that of the PAMP or ADT groups(10-8 mol?L-1,P