RT Journal Article
SR Electronic
T1 Adrenomedullin optimizes mortality prediction in COPD
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP P524
VO 44
IS Suppl 58
A1 Marjolein Brusse-Keizer
A1 Maaike Zuur-Telgen
A1 Job van der Palen
A1 Paul vanderValk
A1 Huib Kerstjens
A1 Wim Boerrsma
A1 Francesco Blasi
A1 Kostantinos Kostikas
A1 Branislava Milenkovic
A1 Michael Tamm
A1 Daiana Stolz
YR 2014
UL http://erj.ersjournals.com/content/44/Suppl_58/P524.abstract
AB In current multicomponent scores that predict mortality in COPD, the systemic component of COPD is under reflected. Therefore, we evaluated the accuracy of plasma proadrenomedulin levels (proADM) alone or combined with the ADO (Age, Dyspnea and airflow Obstruction), updated ADO or BOD (Body mass index, airflow Obstruction, Dyspnea) index to predict all-cause mortality in stable COPD patients.This study is a pooled analysis of 1285 patients from the COMIC and PROMISE-COPD studies. Patients were categorized into low and high risk based on proADM level (<0.87 or ≥ 0.87nmol/L), ADO (< 6 or ≥ 6), updated ADO (<10 or ≥ 10) and BOD index (<4 or ≥ 4). Furthermore, combinations of risks based on the indices and proADM (low/low, low/high, high/low and high/high) were made, which resulted in the ADOA, ADOAupdated and BODA index.Patients with high proADM levels had a 2.1 fold (p<0.001) higher risk of dying than those with lower levels. Based on the C-statistic, solely proADM (C=0.77) was the most accurate predictor of all-cause mortality followed by ADOA and BODA (both C=0.75) ADOAupdated (C =0.74), ADO and BOD (both C=0.72), and ADOupdated index(C=0.70). Adding proADM to ADO and BOD showed superior ability to forecast 1-year and 2-year non-survival, with respectively a 1-year and 2-year mortality net correct reclassification of 57% (95CI 33-80) and 47% (95CI 29-64) for ADO, 58% (95CI 35-81) and 48% (95CI 30-66) for ADOupdated and 59% (95CI 36-83) and 53% (95CI 35-71) for BOD.Levels of proADM measured in stable state showed to be a powerful predictor of all-cause mortality in COPD. It predicted mortality more accurately than the ADO, the updated ADO, and BOD index. Adding proADM increased the predictive probability of all indices.