title: Proadrenomedullin, a useful tool for risk stratification in high Pneumonia Severity Index score community acquired pneumonia.
abstract: The aim of the present study was, first, to evaluate the prognostic value of mid-regional proadrenomedullin (proADM) in emergency department (ED) patients with a diagnosis of community acquired pneumonia (CAP) and, second, to analyze the added value of proADM as a risk stratification tool in comparison with other biomarkers and clinical severity scores. We evaluated proADM, C-reactive protein and procalcitonin, along with the Pneumonia Severity Index (PSI) score in consecutive CAP patients. Ability to predict 30-day mortality was assessed using receiver operating characteristic curve analysis, logistic regression, and reclassification metrics for all patients and for patients with high PSI scores. Primary outcome was death within 30 days after ED admission. One hundred nine patients were included (median age [interquartile range] 71 [27] years). Nine patients died within 30 days. A significant correlation between proADM and PSI was found (ρ = 0.584, P < .001). PSI and proADM levels were significantly predictive of risk of death. In patients with PSI class IV and V (score >90), proADM levels significantly predicted risk of death (OR [95% CI], 4.681 (1.661-20.221), P = .012) whereas PSI score did not (P = .122). ROC(AUC) (area under the receiver operating characteristic curve) was higher for proADM than for PSI score (ROC(AUC) [95% CI], 0.810 [0.654-0.965] and 0.669 [0.445-0.893] respectively). Reclassification analysis revealed that combination of PSI and proADM allows a better risk assessment than PSI alone (P = .001). MR-proADM may be helpful in individual risk stratification of CAP patients with a high PSI score in the ED, allowing to a better identification of patients at risk of death.
authors.affiliation: Department of Biochemistry, Lapeyronie Hospital, 191 Avenue du Doyen Gaston Giraud, 34295 Montpellier cedex 5, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Courtais
authors.forename: Nils
authors.initials: N
authors.lastname: Kuster
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Dupuy
authors.forename: Margit
authors.initials: M
authors.lastname: Folschveiller
authors.forename: Riad
authors.initials: R
authors.lastname: Jreige
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Bargnoux
authors.forename: Julie
authors.initials: J
authors.lastname: Guiot
authors.forename: Sophie
authors.initials: S
authors.lastname: Lefebvre
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Cristol
authors.forename: Mustapha
authors.initials: M
authors.lastname: Sebbane
mesh_terms: D053607:Adrenomedullin / Q000097:blood*; D000368:Aged; D015415:Biomarkers; D002097:C-Reactive Protein / Q000378:metabolism; D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D017714:Community-Acquired Infections / Q000097:blood* / Q000401:mortality*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D011014:Pneumonia / Q000097:blood* / Q000401:mortality*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D012372:ROC Curve; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; C088633:proadrenomedullin; D053607:Adrenomedullin; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide