title: Prognostic value of serum pregnancy-associated plasma protein A level at the initial ED presentation in elderly patients with CAP.
abstract: OBJECTIVE
  This study aims to compare serum pregnancy-associated plasma protein A (PAPP-A) levels in surviving and nonsurviving elderly patients with community-acquired pneumonia (CAP), investigating whether PAPP-A is correlated with CAP prediction scores and whether PAPP-A can successfully predict 28-day mortality rates in elderly patients.
  
  
  METHODS
  This prospective, observational, single-center, cross-sectional study was conducted at the emergency department (ED) of Celal Bayar University Hospital in Manisa, Turkey, between January and September 2014. All patients underwent follow-up evaluations 28 days after admission. The end point was defined as all-cause mortality.
  
  
  RESULTS
  A total of 100 elderly patients (mean age, 77.3 ± 7.6 years [range, 65-94 years]); 60% men) with CAP were enrolled in this study. All-cause mortality at the 28-day follow-up evaluation was 22%. Admission PAPP-A levels were significantly higher in nonsurvivors compared with 28-day survivors (10.3 ± 4.5 vs 3.8 ± 2.6 ng/mL, P < .001). A significant and positive correlation between admission PAPP-A levels and pneumonia severity index; confusion, oxygen saturation, respiratory rate, blood pressure, and age 75 years or older; and confusion, urea, respiratory rate, blood pressure, and age older than 65 years scores was found (r = .440, P < .001; r = .395, P < .001; and r = .359, P < .001, respectively). Moreover, we determined that the optimal PAPP-A cutoff for predicting 28-day mortality at the time of ED admission was 5.1 ng/mL, with 77.3% sensitivity and 77.9% specificity.
  
  
  CONCLUSIONS
  Serum PAPP-A level is valuable for predicting mortality and the severity of the disease among elderly patients with CAP at ED admission. Thus, PAPP-A might play a further role in the clinical assessment of the severity of CAP.
authors.affiliation: Department of Emergency Medicine, Faculty of Medicine, Celal Bayar University, Manisa, Turkey. Electronic address: dryalcingolcuk@gmail.com.
authors.forename: Yalcin
authors.initials: Y
authors.lastname: Golcuk
authors.affiliation: Department of Clinical Biochemistry, Merkez Efendi State Hospital, Manisa, Turkey.
authors.forename: Burcu
authors.initials: B
authors.lastname: Golcuk
authors.affiliation: Department of Emergency Medicine, Faculty of Medicine, Celal Bayar University, Manisa, Turkey.
authors.forename: Adnan
authors.initials: A
authors.lastname: Bilge
authors.affiliation: Manisa State Hospital, Department of Emergency Medicine, Manisa, Turkey.
authors.forename: Ayhan
authors.initials: A
authors.lastname: Korkmaz
authors.affiliation: Department of Emergency Medicine, Faculty of Medicine, Celal Bayar University, Manisa, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Irik
authors.affiliation: Department of Emergency Medicine, Faculty of Medicine, Celal Bayar University, Manisa, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Hayran
authors.affiliation: Department of Clinical Biochemistry, Merkez Efendi State Hospital, Manisa, Turkey.
authors.forename: Alper Tunga
authors.initials: AT
authors.lastname: Ozdemir
authors.affiliation: Department of Clinical Biochemistry, Buca Seyfi Demirsoy State Hospital, Izmir, Turkey.
authors.forename: Yusuf
authors.initials: Y
authors.lastname: Kurtulmus
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017714:Community-Acquired Infections / Q000097:blood* / Q000175:diagnosis / Q000401:mortality*; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D011014:Pneumonia / Q000097:blood* / Q000175:diagnosis / Q000401:mortality*; D011237:Predictive Value of Tests; D011266:Pregnancy-Associated Plasma Protein-A / Q000378:metabolism*; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D015996:Survival Rate
chemical_list: D011266:Pregnancy-Associated Plasma Protein-A