title: Effectiveness of Proadrenomedullin Enhanced CURB65 Score Algorithm in Patients with Community-Acquired Pneumonia in "Real Life", an Observational Quality Control Survey.
abstract: BACKGROUND
  An intervention trial found a trend for shorter length of stay (LOS) in patients with community-acquired pneumonia (CAP) when the CURB65 score was combined with the prognostic biomarker proadrenomedullin (ProADM) (CURB65-A). However, the efficacy and safety of CURB65-A in real life situations remains unclear.
  
  
  METHODS
  From September, 2011, until April, 2012, we performed a post-study prospective observational quality control survey at the cantonal Hospital of Aarau, Switzerland of consecutive adults with CAP. The primary endpoint was length of stay (LOS) during the index hospitalization and within 30 days. We compared the results with two well-defined historic cohorts of CAP patients hospitalized in the same hospital with the use of multivariate regression, namely 83 patients in the observation study without ProADM (OPTIMA I) and the 169 patients in the intervention study (OPTIMA II RCT).
  
  
  RESULTS
  A total of 89 patients with confirmed CAP were included. As compared to patients with CURB65 only observed in the OPTIMA I study, adjusted regression analysis showed a significant shorter initial LOS (7.5 vs. 10.4 days; -2.32; 95% CI, -4.51 to -0.13; p = 0.04) when CURB65-A was used in clinical routine. No significant differences were found for LOS within 30 days. There were no significant differences in safety outcomes in regard to mortality and ICU admission between the cohorts.
  
  
  CONCLUSIONS
  This post-study survey provides evidence that the use of ProADM in combination with CURB65 (CURB65-A) in "real life" situations reduces initial LOS compared to the CURB65 score alone without apparent negative effects on patient safety.
authors.affiliation: Medical University Department, University of Basel, Kantonsspital Aarau, Tellstrasse, Aarau 5001, Switzerland. dany.widmer@gmx.ch.
authors.forename: Daniel
authors.initials: D
authors.lastname: Widmer
authors.affiliation: Medical University Department, University of Basel, Kantonsspital Aarau, Tellstrasse, Aarau 5001, Switzerland. daniel.drozdov@ksa.ch.
authors.forename: Daniel
authors.initials: D
authors.lastname: Drozdov
authors.affiliation: Medical University Department, University of Basel, Kantonsspital Aarau, Tellstrasse, Aarau 5001, Switzerland. kristina.rueegger@unibas.ch.
authors.forename: Kristina
authors.initials: K
authors.lastname: Rüegger
authors.affiliation: Medical University Department, University of Basel, Kantonsspital Aarau, Tellstrasse, Aarau 5001, Switzerland. alexander.litke@ksa.ch.
authors.forename: Alexander
authors.initials: A
authors.lastname: Litke
authors.affiliation: Medical University Department, University of Basel, Kantonsspital Aarau, Tellstrasse, Aarau 5001, Switzerland. birsen.arici@unibas.ch.
authors.forename: Birsen
authors.initials: B
authors.lastname: Arici
authors.affiliation: Medical University Department, University of Basel, Kantonsspital Aarau, Tellstrasse, Aarau 5001, Switzerland. kristina.rueegger@unibas.ch.
authors.forename: Katharina
authors.initials: K
authors.lastname: Regez
authors.affiliation: Medical University Department, University of Basel, Kantonsspital Aarau, Tellstrasse, Aarau 5001, Switzerland. merih.guglielmetti@ksa.ch.
authors.forename: Merih
authors.initials: M
authors.lastname: Guglielmetti
authors.affiliation: Medical University Department, University of Basel, Kantonsspital Aarau, Tellstrasse, Aarau 5001, Switzerland. ursula.schild@ksa.ch.
authors.forename: Ursula
authors.initials: U
authors.lastname: Schild
authors.affiliation: Department of Clinical Nursing Science, Kantonsspital Aarau, Tellstrasse, Aarau 5001, Switzerland. antoinette.conca@ksa.ch.
authors.forename: Antoinette
authors.initials: A
authors.lastname: Conca
authors.affiliation: Department of Clinical Nursing Science, Kantonsspital Aarau, Tellstrasse, Aarau 5001, Switzerland. petra.schaefer-keller@alumnibasel.ch.
authors.forename: Petra
authors.initials: P
authors.lastname: Schäfer
authors.affiliation: Medical University Department, University of Basel, Kantonsspital Aarau, Tellstrasse, Aarau 5001, Switzerland. rita.bossartkouegbe@ksa.ch.
authors.forename: Rita Bossart
authors.initials: RB
authors.lastname: Kouegbe
authors.affiliation: Department of Clinical Nursing Science, Kantonsspital Aarau, Tellstrasse, Aarau 5001, Switzerland. barbara.reutlinger@ksa.ch.
authors.forename: Barbara
authors.initials: B
authors.lastname: Reutlinger
authors.affiliation: Medical University Department, University of Basel, Kantonsspital Aarau, Tellstrasse, Aarau 5001, Switzerland. claudine.blum@ksa.ch.
authors.forename: Claudine
authors.initials: C
authors.lastname: Blum
authors.affiliation: Medical University Department, University of Basel, Kantonsspital Aarau, Tellstrasse, Aarau 5001, Switzerland. philipp.schuetz@ksa.ch.
authors.forename: Philipp
authors.initials: P
authors.lastname: Schuetz
authors.affiliation: Division of Pulmonary Medicine, Kantonsspital Aarau, Tellstrasse, Aarau 5001, Switzerland. sarosh.irani@ksa.ch.
authors.forename: Sarosh
authors.initials: S
authors.lastname: Irani
authors.affiliation: Department of Laboratory Medicine, Kantonsspital Aarau, Tellstrasse, Aarau 5001, Switzerland. andreas.huber@ksa.ch.
authors.forename: Andreas
authors.initials: A
authors.lastname: Huber
authors.affiliation: Department of Emergency Medicine, Kantonsspital Aarau, Tellstrasse, Aarau 5001, Switzerland. ulrich.buergi@ksa.ch.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Bürgi
authors.affiliation: Medical University Department, University of Basel, Kantonsspital Aarau, Tellstrasse, Aarau 5001, Switzerland. beat.mueller@ksa.ch.
authors.forename: Beat
authors.initials: B
authors.lastname: Müller
authors.affiliation: Division of Infectious Diseases and Hospital Hygiene, Cantonal Hospital St. Gallen, Rorschacherstrasse 95, St. Gallen CH-9007, Switzerland. werner.albrich@kssg.ch.
authors.forename: Werner C
authors.initials: WC
authors.lastname: Albrich
keywords: CURB65; biomarkers; clinical scores; pneumonia; proadrenomedullin