RESUMO
BACKGROUND: Midregional-proadrenomedullin (MR-proADM) is a useful prognostic peptide in severe infectious pathologies in the adult population. However, there are no studies that analyze its utility in febrile urinary tract infection (fUTI) in children. An accurate biomarker would provide an early detection of patients with kidney damage, avoiding other invasive tests like renal scintigraphy scans. Our objective is to study the usefulness of MR-proADM as a biomarker of acute and chronic renal parenchymal damage in fUTI within the pediatric population. METHODS: A prospective cohort study was conducted in pediatric patients with fUTI between January 2015 and December 2018. Plasma and urine MR-proADM levels were measured at admission in addition to other laboratory parameters. After confirmation of fUTI, renal scintigraphy scans were performed during the acute and follow-up stages. A descriptive study has been carried out and sensitivity, specificity and ROC curves for MR-proADM, C-reactive protein, and procalcitonin were calculated. RESULTS: 62 pediatric patients (34 female) were enrolled. Scintigraphy showed acute pyelonephritis in 35 patients (56.5%). Of those patients, the median of plasmatic MR-proADM (P-MR-proADM) showed no differences compared to patients without pyelonephritis. 7 patients (11.3%) developed renal scars (RS). Their median P-MR-proADM levels were 1.07 nmol/L (IQR 0.66-1.59), while in patients without RS were 0.48 nmol/L (0.43-0.63) (p < 0.01). The AUC in this case was 0.92 (95% CI 0.77-0.99). We established an optimal cut-off point at 0.66 nmol/L with sensitivity 83.3% and specificity 81.8%. CONCLUSION: MR-ProADM has demonstrated a poor ability to diagnose pyelonephritis in pediatric patients with fUTI. However, P-MR-proADM proved to be a very reliable biomarker for RS prediction.
Assuntos
Infecções Urinárias , Adrenomedulina , Biomarcadores , Criança , Feminino , Humanos , Rim , Masculino , Prognóstico , Estudos Prospectivos , Precursores de Proteínas , Infecções Urinárias/diagnósticoAssuntos
Humanos , Doença pelo Vírus Ebola/diagnóstico , Ebolavirus/isolamento & purificação , Ebolavirus/patogenicidade , Técnicas de Laboratório Clínico/métodos , Técnicas de Laboratório Clínico/normas , Técnicas de Laboratório Clínico , Testes Laboratoriais/prevenção & controle , Testes Laboratoriais/políticas , Testes Laboratoriais/estatística & dados numéricos , Técnicas de Laboratório Clínico/tendências , Testes Laboratoriais/ética , Testes Laboratoriais/legislação & jurisprudênciaRESUMO
Introducción Estudio de un brote de hepatitis C.Métodos Estudio de casos y controles. Se estudiaron pacientes con hepatitis C aguda y controles adecuados. Se estudió la odds ratio (OR) para varios factores de riesgo. Resultados Se estudiaron 7 casos y 46 controles. Se identificó como factor de riesgo el tener implantado un catéter central (OR=35; intervalo de confianza del 95%: 16,0 a 62,0).Conclusión La inadecuada manipulación del catéter con suero salino heparinizado, probablemente contaminado con virus de la hepatitis C, fue la causa del brote (AU)
Introduction Study of an outbreak of hepatitis C virus (HCV) infection. Methods Case-control study. Odds ratios for various risk factors were studied in patients with acute hepatitis C and an appropriate control group. Results Seven cases and 46 controls were included. Implantation of a central catheter was found to be an independent risk factor for hepatitis C (OR=35; 95% CI: 16.062.0).Conclusion Inadequate manipulation of central catheters with heparinized saline solution, which was likely to be HCV-contaminated, caused the outbreak (AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Neoplasias/complicações , Serviço Hospitalar de Oncologia , Hepatite C/epidemiologia , Cateterismo Venoso Central/efeitos adversos , Infecção Hospitalar/epidemiologia , Surtos de Doenças , Fatores de Risco , Cloreto de Sódio/efeitos adversos , Espanha/epidemiologia , Neoplasias/tratamento farmacológico , Hospedeiro Imunocomprometido , Infusões Intravenosas , Heparina/administração & dosagem , Hepatite C/etiologia , Hospitais Universitários , Contaminação de Medicamentos , Infecção Hospitalar/etiologia , Estudos de Casos e Controles , Antineoplásicos/administração & dosagem , Antineoplásicos/uso terapêutico , Doença AgudaRESUMO
INTRODUCTION: Study of an outbreak of hepatitis C virus (HCV) infection. METHODS: Case-control study. Odds ratios for various risk factors were studied in patients with acute hepatitis C and an appropriate control group. RESULTS: Seven cases and 46 controls were included. Implantation of a central catheter was found to be an independent risk factor for hepatitis C (OR=35; 95% CI: 16.0-62.0). CONCLUSION: Inadequate manipulation of central catheters with heparinized saline solution, which was likely to be HCV-contaminated, caused the outbreak.
