title: Mid-regional pro-adrenomedullin improves disposition strategies for patients with acute dyspnoea: results from the BACH trial.
abstract: OBJECTIVE
  To assess the value of mid-regional pro-adrenomedullin (MR-proADM) in guiding patient disposition from the emergency department (ED), as one of the key factors of hospital resource utilisation, in undifferentiated patients with acute dyspnoea.
  
  
  METHODS
  We used clinical and outcome data from a large international biomarker study (BACH trial) and analysed data of all 1557 patients of the European and US sites presenting with acute dyspnoea. Patients were discharged or transferred from the ED to different levels of care (general ward, monitoring unit, intensive care unit). This original patient disposition was compared with the hypothetical disposition based on an adapted method of net reclassification improvement (NRI), which upgraded or downgraded patients from one level of care to the other based on the MR-proADM test result.
  
  
  RESULTS
  MR-pro-ADM was significantly higher in patients who died during the follow-up than in survivors (p<0.0001). When applying the adapted NRI model, 30 additional patients from the European Union (EU) and 55 additional patients from USA were theoretically discharged (increase of 16.5%) if MR-proADM had been used for patient management. The overall NRI, adding up the rates of upgrades and downgrades, in the EU was 16.0% (95% CI 8.2% to 23.9%). A total of n=72 (9.9%) patients changed disposition when adding MR-pro ADM. In the USA, the overall NRI was 12.0% (5.7%-18.4%) and a total of n=81 (11.2%) patients changed disposition.
  
  
  CONCLUSIONS
  MR-proADM has the potential to guide initial disposition of undifferentiated ED patients with acute dyspnoea and might therefore be helpful to improve resource utilisation and patient care.
authors.affiliation: Department of Cardiology and Emergency Medicine Unit, Charité-Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Möckel
authors.forename: Julia
authors.initials: J
authors.lastname: Searle
authors.forename: Oliver
authors.initials: O
authors.lastname: Hartmann
authors.forename: Stefan D
authors.initials: SD
authors.lastname: Anker
authors.forename: W Frank
authors.initials: WF
authors.lastname: Peacock
authors.forename: Alan H B
authors.initials: AH
authors.lastname: Wu
authors.forename: Alan
authors.initials: A
authors.lastname: Maisel
authors.forename: Anna
authors.initials: A
authors.lastname: Slagman
authors.forename: Jörn Ole
authors.initials: JO
authors.lastname: Vollert
authors.forename: Jana
authors.initials: J
authors.lastname: Papassotiriou
authors.forename: Inder
authors.initials: I
authors.lastname: Anand
authors.forename: Robert
authors.initials: R
authors.lastname: Christenson
authors.forename: Lori B
authors.initials: LB
authors.lastname: Daniels
authors.forename: Gerasimos S
authors.initials: GS
authors.lastname: Filippatos
authors.forename: Christopher
authors.initials: C
authors.lastname: Hogan
authors.forename: Nils
authors.initials: N
authors.lastname: Morgenthaler
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
authors.forename: Sean-Xavier
authors.initials: SX
authors.lastname: Neath
authors.forename: Leong
authors.initials: L
authors.lastname: Ng
authors.forename: Richard
authors.initials: R
authors.lastname: Nowak
authors.forename: Mark
authors.initials: M
authors.lastname: Richards
authors.forename: Salvatore
authors.initials: S
authors.lastname: Di Somma
authors.forename: Piotr
authors.initials: P
authors.lastname: Ponikowski
mesh_terms: D000208:Acute Disease; D053607:Adrenomedullin / Q000097:blood*; D000368:Aged; D015415:Biomarkers / Q000097:blood; D004417:Dyspnea / Q000175:diagnosis* / Q000401:mortality; D005060:Europe / Q000453:epidemiology; D005062:European Union; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D016019:Survival Analysis
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D011498:Protein Precursors; C574167:mid-regional pro-adrenomedullin, human; D053607:Adrenomedullin