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Original Article

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

Nagwan Saleh¹  , Wafaa Abo El Fotoh¹, Mona Habib², Salem Deraz^1,3

¹Pediatrics department, Faculty of Medicine, Menoufia University, Egypt
²Medical Biochemistry & Molecular Biology, Faculty of Medicine, Menoufia University, Egypt
³Fujurah Hospital, Emirates Health Services (EHS), Unitted Arab of Emirates

Correspondence Nagwan Saleh ,Email: drnagwan80@gmail.com

Received: December 13, 2024; Revised: February 19, 2025   Accepted: February 19, 2025.

Abstract

Background
Pro-adrenomedullin (pro-ADM), the most stable part of 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 pro-ADM, 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 pro-ADM).
Results
The mean SAA and pro-ADM 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 pro-ADM (61% vs. 52%, respectively). When used together, the sensitivity of the two tests for predicting mortality increased to 70%. The two tests exhibited fair specificity (57%).
Conclusion
SAA and pro-ADM are promising biomarkers for diagnosing and predicting outcomes of pediatric sepsis.

Keywords :Amyloid A; Biomarkers; Children; Critically ill; Pro-adrenomedullin