Serum amyloid A and proadrenomedullin as early markers in critically ill children with sepsis.

Background: Proadrenomedullin (proADM), the most stable part of adrenomedullin (ADM), serves as an indirect marker of ADM levels. Serum amyloid A (SAA) is a protein produced primarily in the liver during acute inflammation.

Purpose: To assess the role of SAA and proADM, individually and in combination, as diagnostic and prognostic markers in pediatric sepsis.

Methods: This prospective case-control cohort study included 65 critically ill children admitted to the pediatric intensive care unit (PICU) and 31 controls. The study grouped the cases by confirmed diagnosis of sepsis, severe sepsis, or septic shock. All children included in this study underwent PICU scoring, routine laboratory investigations, and specific serum biomarker assessments (SAA and proADM).

Results: The mean SAA and proADM levels were significantly higher in the patients versus controls. Both markers were elevated in patients with sepsis, with even higher levels observed in those with severe sepsis and septic shock. SAA demonstrated greater sensitivity for predicting mortality than proADM (61% vs. 52%, respectively). When used together, the sensitivity of the 2 tests for predicting mortality increased to 70%. The 2 tests exhibited fair specificity (57%).

Conclusion: SAA and proADM are promising biomarkers for diagnosing and predicting outcomes of pediatric sepsis.