title: Usefulness of midregional proadrenomedullin to predict poor outcome in patients with community acquired pneumonia.
abstract: BACKGROUND
  midregional proadrenomedullin (MR-proADM) is a prognostic biomarker in patients with community-acquired pneumonia (CAP). We sought to confirm whether MR-proADM added to Pneumonia Severity Index (PSI) improves the potential prognostic value of PSI alone, and tested to what extent this combination could be useful in predicting poor outcome of patients with CAP in an Emergency Department (ED).
  
  
  METHODS
  Consecutive patients diagnosed with CAP were enrolled in this prospective, single-centre, observational study. We analyzed the ability of MR-proADM added to PSI to predict poor outcome using receiver operating characteristic (ROC) curves, logistic regression and risk reclassification and comparing it with the ability of PSI alone. The primary outcome was "poor outcome", defined as the incidence of an adverse event (ICU admission, hospital readmission, or mortality at 30 days after CAP diagnosis).
  
  
  RESULTS
  226 patients were included; 33 patients (14.6%) reached primary outcome. To predict primary outcome the highest area under curve (AUC) was found for PSI (0.74 [0.64-0.85]), which was not significantly higher than for MR-proADM (AUC 0.72 [0.63-0.81, p > 0.05]). The combination of PSI and MR-proADM failed to improve the predictive potential of PSI alone (AUC 0.75 [0.65-0.85, p=0.56]). Ten patients were appropriately reclassified when the combined PSI and MR-proADM model was used as compared with the model of PSI alone. Net reclassification improvement (NRI) index was statistically significant (7.69%, p = 0.03) with an improvement percentage of 3.03% (p = 0.32) for adverse event, and 4.66% (P = 0.02) for no adverse event.
  
  
  CONCLUSIONS
  MR-proADM in combination with PSI may be helpful in individual risk stratification for short-term poor outcome of CAP patients, allowing a better reclassification of patients compared with PSI alone.
authors.affiliation: Emergency Department, Hospital General Universitario "Gregorio Marañón", Madrid, Spain.
authors.forename: Susana
authors.initials: S
authors.lastname: Gordo-Remartínez
authors.affiliation: Emergency Department, Hospital General Universitario "Gregorio Marañón", Madrid, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Calderón-Moreno
authors.affiliation: Emergency Department, Hospital General Universitario "Gregorio Marañón", Madrid, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Fernández-Herranz
authors.affiliation: Emergency Department, Hospital General Universitario "Gregorio Marañón", Madrid, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Castuera-Gil
authors.affiliation: Emergency Department, Hospital General Universitario "Gregorio Marañón", Madrid, Spain.
authors.forename: Mar
authors.initials: M
authors.lastname: Gallego-Alonso-Colmenares
authors.affiliation: Biochemical Department, Hospital General Universitario "Gregorio Marañón", Madrid, Spain.
authors.forename: Carolina
authors.initials: C
authors.lastname: Puertas-López
authors.affiliation: Emergency Department, Hospital General Universitario "Gregorio Marañón", Madrid, Spain.
authors.forename: José A
authors.initials: JA
authors.lastname: Nuevo-González
authors.affiliation: Emergency Department, Hospital General Universitario "Gregorio Marañón", Madrid, Spain.
authors.forename: Domingo
authors.initials: D
authors.lastname: Sánchez-Sendín
authors.affiliation: Emergency Department, Hospital General Universitario "Gregorio Marañón", Madrid, Spain.
authors.forename: Mercedes
authors.initials: M
authors.lastname: García-Gámiz
authors.affiliation: Emergency Department, Hospital General Universitario "Gregorio Marañón", Madrid, Spain.
authors.forename: José A
authors.initials: JA
authors.lastname: Sevillano-Fernández
authors.affiliation: Internal Medicine Department, Hospital General Universitario "Gregorio Marañón", Madrid, Spain; Department of Medicine. Facultad de Medicina. Universidad Complutense de Madrid, Spain.
authors.forename: Luis A
authors.initials: LA
authors.lastname: Álvarez-Sala
authors.affiliation: Emergency Department, Hospital General Universitario "Gregorio Marañón", Madrid, Spain; Department of Medicine. Facultad de Medicina. Universidad Complutense de Madrid, Spain.
authors.forename: Juan A
authors.initials: JA
authors.lastname: Andueza-Lillo
authors.affiliation: Internal Medicine Department, Hospital General Universitario "Gregorio Marañón", Madrid, Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: de Miguel-Yanes
mesh_terms: D053607:Adrenomedullin / Q000097:blood*; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D017714:Community-Acquired Infections / Q000097:blood* / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000097:blood* / Q000473:pathology*; D011379:Prognosis; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D011498:Protein Precursors; C088633:proadrenomedullin; D053607:Adrenomedullin