Adrenomedullin optimises mortality prediction in COPD patients.
BACKGROUND
Current multicomponent scores that predict mortality in COPD patients might underestimate the systemic component of COPD. Therefore, we evaluated the accuracy of circulating levels of proadrenomedullin (MR-proADM) alone or combined with the ADO (Age, Dyspnoea, airflow Obstruction), updated ADO or BOD (Body mass index, airflow Obstruction, Dyspnoea) index to predict all-cause mortality in stable COPD patients.


METHODS
This study pooled data of 1285 patients from the COMIC and PROMISE-COPD study.


RESULTS
Patients with high MR-proADM levels (≥0.87 nmol/l) had a 2.1 fold higher risk of dying than those with lower levels (p < 0.001). Based on the C-statistic, the ADOA index (ADO plus MR-proADM) (C = 0.72) was the most accurate predictor followed by the BODA (BOD plus MR-proADM) (C = 0.71) and the updated ADOA index (updated ADO plus MR-proADM) (C = 0.70). Adding MR-proADM to ADO and BOD was superior in forecasting 1- and 2-year mortality. The net percentages of persons with events correctly reclassified (NRI+) within respectively 1-year and 2-year was 31% and 20% for ADO, 31% and 20% for updated ADO and 25% and 19% for BOD. The net percentages of persons without events correctly reclassified (NRI-) within respectively 1-year and 2-year was 26% and 27% for ADO, 27% and 28% for updated ADO and 34% and 34% for BOD.


CONCLUSIONS
Adding MR-proADM increased the predictive power of BOD, ADO and updated ADO index.
Medical School Twente, Medisch Spectrum Twente, Enschede, The Netherlands. Electronic address: m.brusse-keizer@mst.nl.
Marjolein
M
Brusse-Keizer
Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, The Netherlands.
Maaike
M
Zuur-Telgen
Medical School Twente, Medisch Spectrum Twente, Enschede, The Netherlands; Department of Research Methodology, Measurement, and Data Analysis, University of Twente, Enschede, The Netherlands.
Job
J
van der Palen
Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, The Netherlands.
Paul
P
VanderValk
University Of Groningen, University Medical Centre Groningen, Department of Pulmonary Medicine, and Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands.
Huib
H
Kerstjens
Department of Pneumology, Medisch Centrum Alkmaar, Alkmaar, The Netherlands.
Wim
W
Boersma
Department of Pathophysiology and Transplantation, University of Milan, IRCCS Fondazione Cà Granda Milan, Italy.
Francesco
F
Blasi
Department of Pneumonology, University Thessaly Medical School, Larissa, Greece.
Konstantinos
K
Kostikas
Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Clinic for Pulmonary Diseases, Clinical Center of Serbia, Belgrade, Serbia.
Branislava
B
Milenkovic
Clinic of Pneumology and Respiratory Cell Research, University Hospital Basel, Basel, Switzerland.
Michael
M
Tamm
Clinic of Pneumology and Respiratory Cell Research, University Hospital Basel, Basel, Switzerland.
Daiana
D
Stolz
D053607:Adrenomedullin / Q000097:blood*; D000368:Aged; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D064887:Observational Studies as Topic; D011379:Prognosis; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood* / Q000401:mortality*; D012720:Severity of Illness Index
D015415:Biomarkers; D011498:Protein Precursors; C088633:proadrenomedullin; D053607:Adrenomedullin
Biomarker; Chronic obstructive pulmonary disease; Mortality determinants