title: Prognostic power of proadrenomedullin in community-acquired pneumonia is independent of aetiology.
abstract: Biomarkers are useful in community-acquired pneumonia (CAP). Recently, midregional (MR) proadrenomedullin (proADM) has been shown to be of potential prognostic use. We sought to determine whether this prognostic role depends on the cause of CAP. We conducted a prospective cohort study of immunocompetent patients with CAP. Pneumonia Severity Index (PSI) and CURB-65 score (confusion (abbreviated mental test score of ≤ 8), urea ≥ 7 mol · L(-1), respiratory rate ≥ 30 breaths · min(-1), blood pressure <90 mmHg systolic or <60 mmHg diastolic, and age ≥ 65 yrs), blood C-reactive protein, procalcitonin, MR-proADM, and microbiological studies were systematically performed. Patients were grouped as bacterial, viral/atypical and mixed CAP, and were followed up at 30, 90 and 180 days, and 1 yr. We recruited 228 CAP patients. Identification of at least one pathogen was achieved in 155 (68%) patients. MR-proADM levels closely correlated with increasing severity scores, and showed an important predictive power for complications and short- and long-term mortality (1 yr). Its addition to PSI and CURB-65 significantly improved their prognostic accuracy. A MR-proADM cut-off of 0.646 nmol · L(-1) identified 92% of patients scored as PSI classes IV and V as high risk. MR-proADM outcome prediction power was not affected by different aetiologies. MR-proADM has high short- and long-term prognostic accuracy, and increases the accuracy of clinical scores. The prognostic value of MR-proADM is not modified by different possible CAP aetiologies.
authors.affiliation: Servicio de Neumología, Hospital Universitario Miguel Servet, Zaragoza, , Spain. sbello@salud.aragon.es
authors.forename: Salvador
authors.initials: S
authors.lastname: Bello
authors.forename: Ana B
authors.initials: AB
authors.lastname: Lasierra
authors.forename: Elisa
authors.initials: E
authors.lastname: Mincholé
authors.forename: Sergio
authors.initials: S
authors.lastname: Fandos
authors.forename: Maria Angeles
authors.initials: MA
authors.lastname: Ruiz
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Vera
authors.forename: Francisco
authors.initials: F
authors.lastname: de Pablo
authors.forename: Miguel
authors.initials: M
authors.lastname: Ferrer
authors.forename: Rosario
authors.initials: R
authors.lastname: Menendez
authors.forename: Antoni
authors.initials: A
authors.lastname: Torres
mesh_terms: D053607:Adrenomedullin / Q000097:blood*; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D002097:C-Reactive Protein / Q000032:analysis; D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D017714:Community-Acquired Infections / Q000097:blood*; D003221:Confusion / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000097:blood; D018410:Pneumonia, Bacterial / Q000097:blood* / Q000150:complications / Q000382:microbiology / Q000401:mortality; D011024:Pneumonia, Viral / Q000097:blood* / Q000150:complications / Q000401:mortality / Q000821:virology; D011379:Prognosis; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D056152:Respiratory Rate; D012720:Severity of Illness Index; D012907:Smoking / Q000453:epidemiology; D014508:Urea / Q000097:blood
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D010446:Peptide Fragments; D011498:Protein Precursors; C574167:mid-regional pro-adrenomedullin, human; C088633:proadrenomedullin; D053607:Adrenomedullin; D014508:Urea; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide