Abstract
Biomarkers are useful in community-acquired pneumonia (CAP). Recently, midregional (MR) proadrenomedullin (proADM) has been shown to be of potential prognostic use. We sought to determine whether this prognostic role depends on the cause of CAP.
We conducted a prospective cohort study of immunocompetent patients with CAP. Pneumonia Severity Index (PSI) and CURB-65 score (confusion (abbreviated mental test score of ≤8), urea ≥7 mol·L−1, respiratory rate ≥30 breaths·min−1, blood pressure <90 mmHg systolic or <60 mmHg diastolic, and age ≥65 yrs), blood C-reactive protein, procalcitonin, MR-proADM, and microbiological studies were systematically performed. Patients were grouped as bacterial, viral/atypical and mixed CAP, and were followed up at 30, 90 and 180 days, and 1 yr.
We recruited 228 CAP patients. Identification of at least one pathogen was achieved in 155 (68%) patients. MR-proADM levels closely correlated with increasing severity scores, and showed an important predictive power for complications and short- and long-term mortality (1 yr). Its addition to PSI and CURB-65 significantly improved their prognostic accuracy. A MR-proADM cut-off of 0.646 nmol·L−1 identified 92% of patients scored as PSI classes IV and V as high risk. MR-proADM outcome prediction power was not affected by different aetiologies.
MR-proADM has high short- and long-term prognostic accuracy, and increases the accuracy of clinical scores. The prognostic value of MR-proADM is not modified by different possible CAP aetiologies.
Footnotes
For editorial comments see page 1060.
Support Statement
The study was partially funded by a 2010 grant from the Aragon Respiratory Apparatus Society, the 2009 Brahms Prize from the José Luis Castaño Foundation for the Development of Clinical Biochemistry of the Spanish Society for Clinical Biochemistry and Molecular Pathology and Brahms Iberia SL. The funding organisations played no role in the study design, data collection and analysis, or manuscript approval. Brahms Iberia SL provided instrumentation and reagents for MR-proADM and, partially, PCT determinations. Sample and Assays Technologies performed free of charge the second PCR viral test in Hamburg, Germany.
Statement of Interest
Statements of interest for A.B. Lasierra and A. Torres, and for the study itself can be found at www.erj.ersjournals.com/site/misc/statements.xhtml
- Received May 16, 2011.
- Accepted September 12, 2011.
- ©ERS 2012
