title: Performance of pro-adrenomedullin for identifying adverse outcomes in community-acquired pneumonia.
abstract: BACKGROUND
  We sought to evaluate the usefulness of biomarkers-procalcitonin (PCT), C-reactive protein (CRP) and proadrenomedullin (pro-ADM)-combined with prognostic scales (PSI, CURB-65 and SCAP score) for identifying adverse outcomes in patients with community-acquired pneumonia (CAP) attending at an Emergency Department (ED).
  
  
  METHODS
  Prospective observational study in a teaching hospital among patients with CAP. In addition to collecting data for the prognostic scales, samples were taken at the ED for assessing PCT, CRP and pro-ADM levels. We compared the prognostic accuracy of these biomarkers with severity scores to predict pneumonia related complications, using the area under the receiver operating characteristics curves (AUC), which evaluates how well the model discriminate between patients who had a pneumonia related complication or not.
  
  
  RESULTS
  A total of 491 patients with CAP were enrolled, 256 being admitted to the hospital and 235 treated as outpatients. Admitted patients had higher biomarker levels than outpatients (p < 0.001). The SCAP score and pro-ADM level had the best AUCs for predicting pneumonia related complications (0.83 and 0.84, respectively). Considering SCAP score plus pro-ADM level, the AUC increased significantly to 0.88. SCAP score class 0 or 1 with a pro-ADM level <0.5 ng/mL was the best indicator for selecting patients for outpatient care.
  
  
  CONCLUSIONS
  A new risk score combining SCAP score with pro-ADM level is useful to classify severity risk in CAP patients and hence supporting decision-making on hospital admission.
authors.affiliation: Pneumology Service, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain. Electronic address: pedropablo.espanayandiola@osakidetza.net.
authors.forename: Pedro P
authors.initials: PP
authors.lastname: España
authors.affiliation: Pneumology Service, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Capelastegui
authors.affiliation: Biochemistry Service, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Mar
authors.affiliation: Research Unit, Basurto University Hospital (Osakidetza) - Health Services Research on Chronic Patients Network (REDISSEC), Bilbao, Bizkaia, Spain.
authors.forename: Amaia
authors.initials: A
authors.lastname: Bilbao
authors.affiliation: Research Unit, Hospital Galdakao-Usansolo - REDISSEC, Galdakao, Bizkaia, Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: Quintana
authors.affiliation: Pneumology Service, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain.
authors.forename: Rosa
authors.initials: R
authors.lastname: Diez
authors.affiliation: Pneumology Service, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain.
authors.forename: Cristobal
authors.initials: C
authors.lastname: Esteban
authors.affiliation: Biochemistry Service, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain.
authors.forename: Edurne
authors.initials: E
authors.lastname: Bereciartua
authors.affiliation: Biochemistry Service, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain.
authors.forename: Unai
authors.initials: U
authors.lastname: Unanue
authors.affiliation: Pneumology Service, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain.
authors.forename: Ane
authors.initials: A
authors.lastname: Uranga
mesh_terms: D053607:Adrenomedullin / Q000097:blood*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis / Q000302:isolation & purification; D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D017714:Community-Acquired Infections / Q000097:blood / Q000150:complications* / Q000175:diagnosis*; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000097:blood / Q000150:complications* / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D012372:ROC Curve; D012720:Severity of Illness Index
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
keywords: Biomarkers; C-reactive protein; Community-acquired pneumonia; Pro-adrenomedulin; Procalcitonin