Midregional Proadrenomedullin as a Prognostic Tool in Community-Acquired Pneumonia.
Chest. 2009 Apr 10;
Authors: Huang DT, Angus DC, Kellum JA, Pugh NA, Weissfeld LA, Struck J, Delude RL, Rosengart MR, Yealy DM
Background Midregional proadrenomedullin (MR-proADM) is a potential prognostic biomarker in patients with community-acquired pneumonia (CAP). Previous work is hampered by sample size and illness spectrum limits. We sought to describe the pattern of MR-proADM in a broad CAP cohort, confirm its prognostic role, and compare its performance to procalcitonin, a novel biomarker of infection. Methods We conducted a multicenter prospective cohort study in 28 community and teaching emergency departments. Patients with a clinical and radiographic diagnosis of CAP were enrolled. We stratified MR-proADM levels a priori into quartiles and quantified severity of illness using the Pneumonia Severity Index (PSI) and CURB-65. Primary outcome was 30-day mortality. Results A total of 1653 patients formed the study cohort. MR-proADM levels consistently rose with PSI Class and 30d mortality (p < .001). MR-proADM had a higher area under the curve for 30-day mortality than procalcitonin (0.76 vs 0.65, p < .001), but adding MR-proADM to PSI in all subjects minimally improved performance. Among low-risk subjects (PSI Classes I-III), mortality was low and did not differ by MR-proADM quartile. However, among high risk subjects (PSI Class IV/V, n = 546), subjects in the highest MR-proADM quartile (n = 232; 42%) had higher 30-day mortality vs those in MR-proADM quartiles 1-3 (23% vs 9%, p < .0001). Similar results were seen with CURB-65. MR-proADM and procalcitonin levels were generally concordant; only 6% of PSI Class IV/V subjects in the highest MR-proADM quartile had very low procalcitonin levels (< 0.1 ng/mL). Conclusions In our multicenter CAP cohort, MR-proADM levels correlate with increasing severity of illness and death. High MR-proADM levels offer additional risk stratification in high risk CAP patients, but otherwise MR-proADM levels do not alter PSI based risk assessment in most CAP patients.
PMID: 19363212 [PubMed - as supplied by publisher]