Usefulness of Midregional Proadrenomedullin to Predict Poor Outcome in Patients with Community Acquired Pneumonia

Abstract

Backgroundmidregional 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).MethodsConsecutive 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).Results226 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.ConclusionMR-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.

Sensitivity and Specificity of Soluble Triggering Receptor Expressed on Myeloid Cells-1, Midregional Proatrial Natriuretic Peptide and Midregional Proadrenomedullin for Distinguishing Etiology and to Assess Severity in Community-Acquired Pneumonia

“…Additionally, this marker has been tested mainly as a marker of severity, although there are data indicating that it can be of value in the diagnosis and prognosis of sepsis and bacterial CAP [9]. Once again, it seems highly likely that modifications of this biomarker occur only in very severe bacterial diseases that are relatively uncommon iamong children with CAP.…”

“…The detection limit that was calculated using the imprecision profile was previously assessed as being 0.02 ng/mL with a probability of 95% for PCT, 0.05 nmol/L for MR-proADM, and 2.1 pmol/L for MR-proANP. sTREM-1, MR-proADM, MR-proANP and PCT were chosen due to the sensitivity and specificity showed in adults with CAP for differentiating viral and bacterial CAP or severe and non-severe CAP [7–9]. Clinical and radiographic information, new biomarkers’ serum level determinations and results on nasopharyngeal samples were not available for the central laboratory of the hospital where routine methods were performed.…”

“…Recently, it has been suggested that soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), midregional proatrial natriuretic peptide (MR-proANP) and midregional proadrenomedullin (MR-proADM) could improve the determination of CAP etiology and severity [7–9]. For all these biomarkers, data collected in adults seem to indicate that their concentrations in body fluids are increased in cases of bacterial infections, particularly in the most severe cases.…”

Predictors of treatment failure and clinical stability in patients with community acquired pneumonia

“…A systematic review of 12 studies confirms that an increased MR proADM is associated with increased risk of short term mortality and that a combination of proADM and CURB-65 is associated with an improved predictive efficacy (90). A sizable Swiss study discovered that ProADM was strong predictor of TF including death with an AUC that was significantly higher than that of CRP but similar to PCT (91)(92)(93). Similarly Copeptin has been shown to be a useful marker of early mortality or ICU admission, more so than other biomarkers (89).…”

Prospective evaluation of biomarkers for prediction of quality of life in community-acquired pneumonia

“…In addition to clinical risk scores, such as the pneumonia severity index (PSI) [13], several inflammatory and/or cardiovascular blood biomarkers such as white blood cells (WBC), C-reactive protein (CRP), procalcitonin (PCT), pro-adrenomedullin (proADM), as well as pro-atrial natriuretic peptide (proANP) have been found helpful for risk prediction [6,[14][15][16][17][18][19][20]. Particularly, proADM [9,6,[21][22][23][24][25][26][27][28][29][30], proANP [9,6,25,[31][32][33] and PCT [10,22,25,31,[34][35][36] have been associated with risk for shortand long-term all-cause mortality as well as other adverse outcomes, such as severity of illness, admission to the intensive care unit (ICU), and disease-specific complications. Yet, there is insufficient evidence whether these clinical parameters and blood biomarkers are also helpful in predicting more subjective QoL outcomes: mens sana in corpore sano?…”