Usefulness of midregional proadrenomedullin to predict poor outcome in patients with community acquired pneumonia
| Autor: | Carolina Puertas-López, María Calderón-Moreno, Mercedes García-Gámiz, Juan Fernández-Herranz, Luis A. Álvarez-Sala, Jose A. Sevillano-Fernández, Susana Gordo-Remartínez, Juan A. Andueza-Lillo, Ana Castuera-Gil, Jose A. Nuevo-Gonzalez, José M. de Miguel-Yanes, Mar Gallego-Alonso-Colmenares, Domingo Sánchez-Sendín |
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| Jazyk: | angličtina |
| Rok vydání: | 2015 |
| Předmět: |
Male
Pediatrics medicine.medical_specialty Pneumonia severity index lcsh:Medicine Logistic regression Severity of Illness Index Adrenomedullin Community-acquired pneumonia Internal medicine Severity of illness Humans Medicine Prospective Studies Protein Precursors Adverse effect Prospective cohort study lcsh:Science Aged Aged 80 and over Multidisciplinary Receiver operating characteristic business.industry lcsh:R Pneumonia Emergency department Middle Aged Prognosis medicine.disease Community-Acquired Infections Female lcsh:Q business Biomarkers Research Article |
| Zdroj: | PLoS ONE, Vol 10, Iss 6, p e0125212 (2015) Repositorio Institucional de la Consejería de Sanidad de la Comunidad de Madrid Consejería de Sanidad de la Comunidad de Madrid PLoS ONE |
| ISSN: | 1932-6203 |
| Popis: | 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. Conclusion 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. |
| Databáze: | OpenAIRE |
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