Lilliam Ambroggio (United States of America)
Children's Hospital Colorado PediatricsAuthor Of 2 Presentations
DISCRIMINATION OF VIRAL FROM BACTERIAL COMMUNITY ACQUIRED PNEUMONIA IN CHILDREN USING URINE METABOLOMICS
Abstract
Backgrounds:
Differentiating bacterial from viral etiologies of pediatric community-acquired pneumonia (CAP) is critical to guiding appropriate therapy. However, current tests are insensitive, invasive, or impractical in children. The objective of this study is to identify candidate metabolomic biomarkers that differentiate bacteria from viral CAP.
Methods
We studied a cohort of children, 3 months-18 years old, with suspected CAP in the emergency department. Patients with chronic medical conditions or who were hospitalized 14 days prior were excluded. Viral and Mycoplasma pneumoniae (Mp) were detected by PCR of nasopharyngeal swabs. Suspected Streptococcus pneumoniae (Sp) was defined as presence of pneumococcal autolysin (lytA) and a procalcitonin of ≥1.5 ng/mL. Urine samples were collected at time of presentation and metabolites were identified and quantified by nuclear magnetic resonance spectroscopy. Metabolomics data were standardized using specific gravity. Demographic and clinical characteristics by patient status ( MP, Sp and viral) were compared using chi-square tests and ANOVA, as applicable. Random forest (RF) was used to determine the most important metabolites and clinical factors to discriminate viral etiology from Mp and Sp.
Results:
Of 160 children, 28 (17.5%) had Mp, 13 (8.1%) had Sp, and 119 (74.4%) had a virus detected by PCR (Table). Most (87%) were between 1-12 years old. The most important variables identified by RF included age, prior history of reactive airways disease, 1-methylnicotinamide, hypoxanthine, tryptophan, quinolinate, valine, trimethylamine-N-oxide, ascorbate, and 4-hydroxybenzoate.
Conclusions/Learning Points:
Metabolites related to inflammatory pathways (e.g., tryptophan, quniolinate) and microbial metabolism (e.g., trimethylamine-N-oxide, 4-hydroxybenzoate) differentiated viral from typical and atypical bacterial CAP in children. Urine metabolomics can identify novel biomarkers to differentiate bacterial from viral CAP in children.
PREDICTING SEVERE PNEUMONIA IN THE EMERGENCY DEPARTMENT: A GLOBAL STUDY OF THE PEDIATRIC EMERGENCY RESEARCH NETWORK (PERN)
Abstract
Backgrounds:
Pneumonia is a frequent and costly cause of emergency department (ED) visits and hospitalizations in children. No validated tools exist to assist with management decisions for children presenting to the ED with community-acquired pneumonia (CAP). Our objective was to develop prediction models to accurately risk stratify children with CAP across a global network of pediatric EDs.
Methods
Prospective study of children 3 months to <14 years old with CAP at 69 EDs in the Pediatric Emergency Research Network. We excluded children with recent hospitalizations, chronic conditions, or critically ill. The primary outcome was an ordinal composite of CAP severity occurring within 7 days: mild (discharged), moderate (hospitalized but not severe), and severe (empyema/effusion requiring drainage, ICU>48 hours, respiratory failure requiring positive-pressure ventilation, septic shock, vasoactive infusions, extracorporeal membrane oxygenation, or death). Multivariable logistic regression was used to develop risk models for moderate/severe disease (vs. mild) and for severe disease (vs. mild or moderate).
Results:
Of 2518 children, 1314 (52.2%) had mild CAP, 1094 (43.4%) moderate, and 110 (4.4%) severe (Table 1). Vomiting, elevated heart rate, elevated respiratory rate, oxygen saturation <90%, altered mental status, retractions, prolonged capillary refill, and pleural effusion were associated with development of moderate/severe CAP (Table 2). Elevated heart rate, asymmetric breath sounds, retractions, and pleural effusion were associated with severe CAP. The AUC for the moderate/severe model was 0.844 (95% CI, 0.828, 0.860) and for the severe model was 0.827 (95% CI, 0.792, 0.862).
Conclusions/Learning Points:
We prospectively derived risk prediction models for pediatric CAP with features easily available at ED presentation in a global cohort of pediatric EDs. Both demonstrated excellent ability to predict moderate/severe disease warranting hospitalization, and severe disease for which intensive care should be considered.
Presenter of 2 Presentations
DISCRIMINATION OF VIRAL FROM BACTERIAL COMMUNITY ACQUIRED PNEUMONIA IN CHILDREN USING URINE METABOLOMICS
Abstract
Backgrounds:
Differentiating bacterial from viral etiologies of pediatric community-acquired pneumonia (CAP) is critical to guiding appropriate therapy. However, current tests are insensitive, invasive, or impractical in children. The objective of this study is to identify candidate metabolomic biomarkers that differentiate bacteria from viral CAP.
Methods
We studied a cohort of children, 3 months-18 years old, with suspected CAP in the emergency department. Patients with chronic medical conditions or who were hospitalized 14 days prior were excluded. Viral and Mycoplasma pneumoniae (Mp) were detected by PCR of nasopharyngeal swabs. Suspected Streptococcus pneumoniae (Sp) was defined as presence of pneumococcal autolysin (lytA) and a procalcitonin of ≥1.5 ng/mL. Urine samples were collected at time of presentation and metabolites were identified and quantified by nuclear magnetic resonance spectroscopy. Metabolomics data were standardized using specific gravity. Demographic and clinical characteristics by patient status ( MP, Sp and viral) were compared using chi-square tests and ANOVA, as applicable. Random forest (RF) was used to determine the most important metabolites and clinical factors to discriminate viral etiology from Mp and Sp.
Results:
Of 160 children, 28 (17.5%) had Mp, 13 (8.1%) had Sp, and 119 (74.4%) had a virus detected by PCR (Table). Most (87%) were between 1-12 years old. The most important variables identified by RF included age, prior history of reactive airways disease, 1-methylnicotinamide, hypoxanthine, tryptophan, quinolinate, valine, trimethylamine-N-oxide, ascorbate, and 4-hydroxybenzoate.
Conclusions/Learning Points:
Metabolites related to inflammatory pathways (e.g., tryptophan, quniolinate) and microbial metabolism (e.g., trimethylamine-N-oxide, 4-hydroxybenzoate) differentiated viral from typical and atypical bacterial CAP in children. Urine metabolomics can identify novel biomarkers to differentiate bacterial from viral CAP in children.
PREDICTING SEVERE PNEUMONIA IN THE EMERGENCY DEPARTMENT: A GLOBAL STUDY OF THE PEDIATRIC EMERGENCY RESEARCH NETWORK (PERN)
Abstract
Backgrounds:
Pneumonia is a frequent and costly cause of emergency department (ED) visits and hospitalizations in children. No validated tools exist to assist with management decisions for children presenting to the ED with community-acquired pneumonia (CAP). Our objective was to develop prediction models to accurately risk stratify children with CAP across a global network of pediatric EDs.
Methods
Prospective study of children 3 months to <14 years old with CAP at 69 EDs in the Pediatric Emergency Research Network. We excluded children with recent hospitalizations, chronic conditions, or critically ill. The primary outcome was an ordinal composite of CAP severity occurring within 7 days: mild (discharged), moderate (hospitalized but not severe), and severe (empyema/effusion requiring drainage, ICU>48 hours, respiratory failure requiring positive-pressure ventilation, septic shock, vasoactive infusions, extracorporeal membrane oxygenation, or death). Multivariable logistic regression was used to develop risk models for moderate/severe disease (vs. mild) and for severe disease (vs. mild or moderate).
Results:
Of 2518 children, 1314 (52.2%) had mild CAP, 1094 (43.4%) moderate, and 110 (4.4%) severe (Table 1). Vomiting, elevated heart rate, elevated respiratory rate, oxygen saturation <90%, altered mental status, retractions, prolonged capillary refill, and pleural effusion were associated with development of moderate/severe CAP (Table 2). Elevated heart rate, asymmetric breath sounds, retractions, and pleural effusion were associated with severe CAP. The AUC for the moderate/severe model was 0.844 (95% CI, 0.828, 0.860) and for the severe model was 0.827 (95% CI, 0.792, 0.862).
Conclusions/Learning Points:
We prospectively derived risk prediction models for pediatric CAP with features easily available at ED presentation in a global cohort of pediatric EDs. Both demonstrated excellent ability to predict moderate/severe disease warranting hospitalization, and severe disease for which intensive care should be considered.
Poster Author Of 1 e-Poster
EP297 - METABOLOMICS DIFFERNTIATES CHILDREN WITH COMMUNITY-ACQUIRED PNEUMONIA FROM CONTROLS USING METABOLOMICS (ID 599)
- Lilliam Ambroggio (United States of America)
- Todd A. Florin (United States of America)
- Kayla Williamson (United States of America)
- Brandie Wagner (United States of America)
- Larisa Yeomans (United States of America)
- Heidi Sucharew (United States of America)
- Maurizio Macaluso (United States of America)
- Richard Ruddy (United States of America)
- Kathleen Stringer (United States of America)
- Samir S. Shah (United States of America)