Proadrenomedullin improves REA-ICU score for predicting Early Severe Community-Acquired Pneumonia.
Chest. 2012 May 31;
Authors: Renaud B, Schuetz P, Claessens YE, Labarère J, Albrich W, Mueller B
Abstract BACKGROUND:Whether proadrenomedullin (ProADM) improves the performance of the Risk of Early Admission to ICU score (REA-ICU score) in predicting early severe Community Acquired Pneumonia (CAP) has never been demonstrated. METHODS:Secondary analysis of the original data from 877 consecutive patients with CAP enrolled in the ProHosp study, a multicenter trial in emergency departments of six tertiary care hospitals in Switzerland. Early severe CAP was defined by either the requirement for mechanical ventilation or vasopressive drugs or occurrence of death within 3 days of emergency department (ED) presentation. RESULTS:Eighty (9.1%) patients developed early severe CAP (47 required mechanical ventilation, 19 vasopressive drugs, and 16 died) within 3 days of ED presentation. They had a higher median ProADM value (2.18 nmol/L vs 1.15 nmol/L, P <0.001). Combining ProADM testing with the REA-ICU score improved the AUC (0.81) compared with either parameter (ProADM [0.73] or REA-ICU score [0.76], P <0.001) and resulted in a net reclassification improvement of 0.20 (P <0.001). A ProADM value ?1.8 nmol/L or assignment to REA-ICU risk classes III-IV predicted early severe CAP with a sensitivity of 76.3% and a negative predictive value of 96.7%. Excluding 21 patients with major criteria of severe CAP on presentation showed similar results. CONCLUSION:These study findings demonstrate that addition of ProADM to the REA-ICU score improves the classification of a substantial proportion of ED patients at intermediate or high risk for early severe CAP, which may translate into better triage decisions.
PMID: 22661450 [PubMed - as supplied by publisher]