title: Mid-regional proadrenomedullin: An early marker of response in critically ill patients with severe community-acquired pneumonia?
abstract: BACKGROUND
  Mid-regional proadrenomedullin (MR-proADM) is a novel biomarker with potential prognostic utility in patients with community-acquired pneumonia (CAP).
  
  
  OBJECTIVE
  To evaluate the value of MR-proADM levels at ICU admission for further severity stratification and outcome prediction, and its kinetics as an early predictor of response in severe CAP (SCAP).
  
  
  METHODS
  Prospective, single-center, cohort study of 19 SCAP patients admitted to the ICU within 12h after the first antibiotic dose.
  
  
  RESULTS
  At ICU admission median MR-proADM was 3.58nmol/l (IQR: 2.83-10.00). No significant association was found between its serum levels at admission and severity assessed by SAPS II (Spearman's correlation=0.24, p=0.31) or SOFA score (SOFA<10: <3.45nmol/l vs. SOFA≥10: 3.90nmol/l, p=0.74). Hospital and one-year mortality were 26% and 32%, respectively. No significant difference in median MR-proADM serum levels was found between survivors and non-survivors and its accuracy to predict hospital mortality was bad (aROC 0.53). After 48h of antibiotic therapy, MR-proADM decreased in all but 5 patients (median -20%; IQR -56% to +0.1%). Its kinetics measured by the percent change from baseline was a good predictor of clinical response (aROC 0.80). The best discrimination was achieved by classifying patients according to whether MR-proADM decreased or not within 48h. No decrease in MR-proADM serum levels significantly increased the chances of dying independently of general severity (SAPS II-adjusted OR 174; 95% CI 2-15,422; p=0.024).
  
  
  CONCLUSIONS
  In SCAP patients, a decrease in MR-proADM serum levels in the first 48h after ICU admission was a good predictor of clinical response and better outcome.
authors.affiliation: Emergency and Intensive Care Department, Centro Hospitalar São João EPE, Porto, Portugal; Department of Medicine, University of Porto Medical School, Porto, Portugal. Electronic address: jmcrpereira@yahoo.com.
authors.forename: J M
authors.initials: JM
authors.lastname: Pereira
authors.affiliation: Hospital Epidemiology Centre, Centro Hospitalar São João EPE, Porto, Portugal; Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Portugal; EPIUnit - Institute of Public Health, University of Porto, Portugal.
authors.forename: A
authors.initials: A
authors.lastname: Azevedo
authors.affiliation: Emergency and Intensive Care Department, Centro Hospitalar São João EPE, Porto, Portugal.
authors.forename: C
authors.initials: C
authors.lastname: Basílio
authors.affiliation: Emergency and Intensive Care Department, Centro Hospitalar São João EPE, Porto, Portugal.
authors.forename: C
authors.initials: C
authors.lastname: Sousa-Dias
authors.affiliation: Emergency and Intensive Care Department, Centro Hospitalar São João EPE, Porto, Portugal; Department of Medicine, University of Porto Medical School, Porto, Portugal.
authors.forename: P
authors.initials: P
authors.lastname: Mergulhão
authors.affiliation: Emergency and Intensive Care Department, Centro Hospitalar São João EPE, Porto, Portugal; Department of Medicine, University of Porto Medical School, Porto, Portugal.
authors.forename: J A
authors.initials: JA
authors.lastname: Paiva
mesh_terms: D053607:Adrenomedullin / Q000097:blood*; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D017714:Community-Acquired Infections / Q000097:blood / Q000188:drug therapy; D016638:Critical Illness; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000097:blood* / Q000188:drug therapy; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers; D011498:Protein Precursors; C088633:proadrenomedullin; D053607:Adrenomedullin
keywords: Biomarkers; Critically ill patients; Outcome; Proadrenomedullin; Severe community acquired pneumonia