title: Thirty and ninety days mortality predictive value of admission and in-hospital procalcitonin and mid-regional pro-adrenomedullin testing in patients with dyspnea. Results from the VERyfing DYspnea trial.
abstract: BACKGROUND
  Mid-regional pro-atrial natriuretic peptide (MR-proANP), procalcitonin (PCT), and mid-regional pro-adrenomedullin (MR-proADM) demonstrated usefulness for management of emergency department patients with dyspnea.
  
  
  METHODS
  To evaluate in patients with dyspnea, the prognostic value for 30 and 90 days mortality and readmission of PCT, MR-proADM, and MR-proANP, a multicenter prospective study was performed evaluating biomarkers at admission, 24 and 72 hours after admission. Based on final diagnosis, patients were divided into acute heart failure (AHF), primary lung diseases, or both (AHF + NO AHF).
  
  
  RESULTS
  Five hundred one patients were enrolled. Procalcitonin and MR-proADM values at admission and at 72 hours were significantly (P < .001) predictive for 30-day mortality: baseline PCT with an area under the curve (AUC) of 0.70 and PCT at 72 hours with an AUC of 0.61; baseline MR-proADM with an AUC of 0.62 and MR-proADM at 72 hours with an AUC of 0.68. As for 90-day mortality, both PCT and MR-proADM baseline and 72 hours values showed a significant (P < .0001) predictive ability: baseline PCT with an AUC of 0.73 and 72 hours PCT with an AUC of 0.64; baseline MR-proADM with an AUC of 0.66 and 72 hours MR-proADM with an AUC of 0.71. In AHF, group biomarkers predicted rehospitalization and mortality at 90 days, whereas in AHF + NO AHF group, they predict mortality at 30 and 90 days.
  
  
  CONCLUSIONS
  In patients admitted for dyspnea, assessment of PCT plus MR-proADM improves risk stratification and management. Combined use of biomarkers is able to predict in the total cohort both rehospitalization and death at 30 and 90 days.
authors.affiliation: Emergency Department, Sant'Andrea Hospital, School of Medicine and Psychology "Sapienza" Univesity, Rome, Italy. Electronic address: francesco.travaglino@gmail.com.
authors.forename: Francesco
authors.initials: F
authors.lastname: Travaglino
authors.affiliation: Emergency Department, Sant'Andrea Hospital, School of Medicine and Psychology "Sapienza" Univesity, Rome, Italy. Electronic address: veryo85@hotmail.it.
authors.forename: Veronica
authors.initials: V
authors.lastname: Russo
authors.affiliation: Emergency Department, Sant'Andrea Hospital, School of Medicine and Psychology "Sapienza" Univesity, Rome, Italy. Electronic address: benedetta.db@gmail.com.
authors.forename: Benedetta
authors.initials: B
authors.lastname: De Berardinis
authors.affiliation: Emergency Medicine Department, Parma Teaching Hospital, Parma, Italy. Electronic address: FNumeroso@ao.pr.it.
authors.forename: Filippo
authors.initials: F
authors.lastname: Numeroso
authors.affiliation: Emergency Medicine Department, Parma Teaching Hospital, Parma, Italy. Electronic address: pamelacatania@live.com.
authors.forename: Pamela
authors.initials: P
authors.lastname: Catania
authors.affiliation: Emergency Medicine Department, Parma Teaching Hospital, Parma, Italy. Electronic address: GCervellin@ao.pr.it.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Cervellin
authors.affiliation: Emergency Medicine Department, San Matteo Teaching Hospital, Pavia, Italy. Electronic address: stefano.genierenigra@email.it.
authors.forename: Stefano Geniere
authors.initials: SG
authors.lastname: Nigra
authors.affiliation: Emergency Medicine Department, San Matteo Teaching Hospital, Pavia, Italy. Electronic address: francescogeraci@gmail.com.
authors.forename: Francesco
authors.initials: F
authors.lastname: Geraci
authors.affiliation: Emergency Medicine Department, San Matteo Teaching Hospital, Pavia, Italy. Electronic address: m.bressan@smatteo.pv.it.
authors.forename: Maria Antonietta
authors.initials: MA
authors.lastname: Bressan
authors.affiliation: Emergency Medicine Department, S. Orsola-Malpighi Teaching Hospital, Bologna, Italy. Electronic address: stefania.guerrini@aosp.bo.it.
authors.forename: Stefania
authors.initials: S
authors.lastname: Guerrini
authors.affiliation: Emergency Medicine Department, S. Orsola-Malpighi Teaching Hospital, Bologna, Italy. Electronic address: mario.cavazza@aosp.bo.it.
authors.forename: Mario
authors.initials: M
authors.lastname: Cavazza
authors.affiliation: Emergency Medicine Department, Maggiore Teaching Hospital, Milan, Italy. Electronic address: christian.folli@policlinico.mi.it.
authors.forename: Christian
authors.initials: C
authors.lastname: Folli
authors.affiliation: Emergency Medicine Department, Maggiore Teaching Hospital, Milan, Italy. Electronic address: vmonzani@policlinico.mi.it.
authors.forename: Valter
authors.initials: V
authors.lastname: Monzani
authors.affiliation: Emergency Medicine Department, Città della Scienza e della Salute Hospital, Turin, Italy. Electronic address: stefania.battista@libero.it.
authors.forename: Stefania
authors.initials: S
authors.lastname: Battista
authors.affiliation: Emergency Medicine Department, Città della Scienza e della Salute Hospital, Turin, Italy. Electronic address: gmengozzi@cittadellasalute.to.it.
authors.forename: Giulio
authors.initials: G
authors.lastname: Mengozzi
authors.affiliation: Emergency Medicine Department, Vittorio Emanuele Teaching Hospital, Catania, Italy. Electronic address: p.noto@hotmail.it.
authors.forename: Paola
authors.initials: P
authors.lastname: Noto
authors.affiliation: Emergency Medicine Department, Vittorio Emanuele Teaching Hospital, Catania, Italy. Electronic address: gcarpinteri@gmail.com.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Carpinteri
authors.affiliation: Internal Medicine Department, SS Giovanni e Paolo Hospital in Venice, University of Padua, Italy. Electronic address: andrea.semplicini@unipd.it.
authors.forename: Andrea
authors.initials: A
authors.lastname: Semplicini
authors.affiliation: Internal Medicine Department, SS Giovanni e Paolo Hospital in Venice, University of Padua, Italy. Electronic address: fede.stella@gmail.com.
authors.forename: Federica
authors.initials: F
authors.lastname: Stella
authors.affiliation: Emergency Medicine Department, San Martino Teaching Hospital, Cenoa University, Italy. Electronic address: stella99@alice.it.
authors.forename: Stella
authors.initials: S
authors.lastname: Ingrassia
authors.affiliation: Emergency Medicine Department, San Martino Teaching Hospital, Cenoa University, Italy. Electronic address: moscatellievandro@gmail.com.
authors.forename: Paolo
authors.initials: P
authors.lastname: Moscatelli
authors.affiliation: Emergency Medicine Department, San Martino Teaching Hospital, Cenoa University, Italy. Electronic address: patriziagiuntini53@gmail.com.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Giuntini
authors.affiliation: Clinical and Molecular Medicine Department Sant'Andrea Hospital, School of Medicine and Psychology "Sapienza" Univesity, Rome, Italy. Electronic address: sagerardo@libero.it.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Salerno
authors.affiliation: Clinical and Molecular Medicine Department Sant'Andrea Hospital, School of Medicine and Psychology "Sapienza" Univesity, Rome, Italy. Electronic address: patrizia.cardelli@uniroma1.it.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Cardelli
authors.affiliation: Emergency Department, Sant'Andrea Hospital, School of Medicine and Psychology "Sapienza" Univesity, Rome, Italy. Electronic address: salvatore.disomma@uniroma1.it.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Di Somma
mesh_terms: D053607:Adrenomedullin / Q000097:blood*; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D004417:Dyspnea / Q000097:blood* / Q000401:mortality*; D004636:Emergency Service, Hospital; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008171:Lung Diseases / Q000097:blood* / Q000401:mortality*; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D018570:Risk Assessment
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D053607:Adrenomedullin; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide