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Varaldo E, Rumbolo F, Prencipe N, Bioletto F, Settanni F, Mengozzi G, Grottoli S, Ghigo E, Brazzi L, Montrucchio G, Berton AM. Effectiveness of Copeptin, MR-proADM and MR-proANP in Predicting Adverse Outcomes, Alone and in Combination with Traditional Severity Scores, a Secondary Analysis in COVID-19 Patients Requiring Intensive Care Admission. J Clin Med 2024; 13:2019. [PMID: 38610784 PMCID: PMC11012433 DOI: 10.3390/jcm13072019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/26/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
Objective: To investigate whether copeptin, MR-proADM and MR-proANP, alone or integrated with the SOFA, MuLBSTA and SAPS II scores, are capable of early recognition of COVID-19 ICU patients at increased risk of adverse outcomes. Methods: For this predefined secondary analysis of a larger cohort previously described, all consecutive COVID-19 adult patients admitted between March and December 2020 to the ICU of a referral, university hospital in Northern Italy were screened, and clinical severity scores were calculated upon admission. A blood sample for copeptin, MR-proADM and MR-proANP was collected within 48 h (T1), on day 3 (T3) and 7 (T7). Outcomes considered were ICU and in-hospital mortality, bacterial superinfection, recourse to renal replacement therapy (RRT) or veno-venous extracorporeal membrane oxygenation, need for invasive mechanical ventilation (IMV) and pronation. Results: Sixty-eight patients were enrolled, and in-hospital mortality was 69.1%. ICU mortality was predicted by MR-proANP measured at T1 (HR 1.005, 95% CI 1.001-1.010, p = 0.049), although significance was lost if the analysis was adjusted for procalcitonin and steroid treatment (p = 0.056). Non-survivors showed higher MR-proADM levels than survivors at all time points, and an increase in the ratio between values at baseline and at T7 > 4.9% resulted in a more than four-fold greater risk of in-hospital mortality (HR 4.417, p < 0.001). Finally, when considering patients with any reduction in glomerular filtration, an early copeptin level > 23.4 pmol/L correlated with a more than five-fold higher risk of requiring RRT during hospitalization (HR 5.305, p = 0.044). Conclusion: Timely evaluation of MR-proADM, MR-proANP and copeptin, as well as changes in the former over time, might predict mortality and other adverse outcomes in ICU patients suffering from severe COVID-19.
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Affiliation(s)
- Emanuele Varaldo
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, 10126 Turin, Italy
| | - Francesca Rumbolo
- Clinical Chemistry and Microbiology Laboratory, S. Croce and Carle Cuneo Hospital, 12100 Cuneo, Italy
| | - Nunzia Prencipe
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, 10126 Turin, Italy
| | - Fabio Bioletto
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, 10126 Turin, Italy
| | - Fabio Settanni
- Division of Clinical Biochemistry, Department of Laboratory Medicine, University of Turin, 10126 Turin, Italy
| | - Giulio Mengozzi
- Division of Clinical Biochemistry, Department of Laboratory Medicine, University of Turin, 10126 Turin, Italy
| | - Silvia Grottoli
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, 10126 Turin, Italy
| | - Ezio Ghigo
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, 10126 Turin, Italy
| | - Luca Brazzi
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy
- Anestesia e Rianimazione 1 U, Department of Anesthesia, Intensive Care and Emergency, Città della Salute e della Scienza Hospital, 10126 Turin, Italy
| | - Giorgia Montrucchio
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy
- Anestesia e Rianimazione 1 U, Department of Anesthesia, Intensive Care and Emergency, Città della Salute e della Scienza Hospital, 10126 Turin, Italy
| | - Alessandro Maria Berton
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, 10126 Turin, Italy
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Moore N, Williams R, Mori M, Bertolusso B, Vernet G, Lynch J, Philipson P, Ledgerwood T, Kidd SP, Thomas C, Garcia-Arias V, Young M, Saeed K, Gordon K, Cortes N. Mid-regional proadrenomedullin (MR-proADM), C-reactive protein (CRP) and other biomarkers in the early identification of disease progression in patients with COVID-19 in the acute NHS setting. J Clin Pathol 2023; 76:400-406. [PMID: 34996755 PMCID: PMC8761594 DOI: 10.1136/jclinpath-2021-207750] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 12/14/2021] [Indexed: 02/02/2023]
Abstract
AIMS There is a lack of biomarkers validated for assessing clinical deterioration in patients with COVID-19 on presentation to secondary or tertiary care. This evaluation looked at the potential clinical application of C reactive protein (CRP), procalcitonin, mid-regional proadrenomedullin (MR-proADM) and white cell count to support prediction of clinical outcomes. METHODS 135 patients presenting to Hampshire Hospitals NHS Foundation Trust between April and June 2020 confirmed to have COVID-19 via reverse-transcription-qPCR were included. Biomarkers from within 24 hours of presentation were used to predict disease progression by Cox regression and area under the receiver operating characteristic curves. The endpoints assessed were 30-day all-cause mortality, intubation and ventilation, critical care admission and non-invasive ventilation (NIV) use. RESULTS Elevated MR-proADM was shown to have the greatest ability to predict 30-day mortality adjusting for age, cardiovascular disease, renal disease and neurological disease. A significant association was also noted between raised MR-proADM and CRP concentrations and the requirement for critical care admission and NIV. CONCLUSIONS The measurement of MR-proADM and CRP in patients with confirmed COVID-19 infection on admission shows significant potential to support clinicians in identifying those at increased risk of disease progression and need for higher level care, subsequently enabling prompt escalation in clinical interventions.
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Affiliation(s)
- Nathan Moore
- Microbiology Department, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Rebecca Williams
- Microbiology Department, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Matilde Mori
- Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Gabrielle Vernet
- Emergency Department, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Jessica Lynch
- Microbiology Department, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Pete Philipson
- University of Newcastle upon Tyne, Newcastle upon Tyne, Tyne and Wear, UK
| | - Thomas Ledgerwood
- Microbiology Department, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Stephen P Kidd
- Microbiology Department, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Claire Thomas
- Microbiology Department, Basingstoke and North Hampshire Hospital, Basingstoke, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Michelle Young
- Biochemsitry Department, Whittington Hospital, London, UK
| | - Kordo Saeed
- Faculty of Medicine, University of Southampton, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Kirsty Gordon
- Biochemistry Department, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Nicholas Cortes
- Microbiology Department, Basingstoke and North Hampshire Hospital, Basingstoke, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
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3
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Angeletti S, Legramante JM, Lia MS, D'Amico L, Fogolari M, Cella E, De Cesaris M, De Angelis F, Pieri M, Terrinoni A, Bernardini S, Minieri M. Assessment of the Stability of Midregional Proadrenomedullin in Different Biological Matrices. Lab Med 2023; 54:41-46. [PMID: 35713618 DOI: 10.1093/labmed/lmac066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Midregional proadrenomedullin (MR-proADM) has been shown to play a key role in endothelial dysfunction, with increased levels helping to prevent early stages of organ dysfunction. Recent clinical evidence has demonstrated MR-proADM to be a helpful biomarker to identify disease severity in patients with sepsis as well as pneumonia. This biomarker is helpful at triage in emergency departments to assess risk level of patients. The aim of this study is to evaluate the stability of MR-proADM in different biological matrices. The results, obtained by Bland-Altman and scatter plot analyses, demonstrate that deviation of MR-proADM concentration in serum compared to EDTA plasma unequivocally shows that serum should not be used as a sample matrix. Instead, the excellent correlation of heparin plasma vs EDTA plasma samples shows that heparin plasma can be used without reservation in clinical routine and emergency samples.
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Affiliation(s)
- Silvia Angeletti
- Unit of Clinical Laboratory Science, University Campus Bio-Medico, Rome, Italy
| | - Jacopo M Legramante
- Emergency Department, Tor Vergata University Hospital, Rome, Italy.,Department of Medical Systems, University of Tor Vergata, Rome, Italy
| | - Maria Stella Lia
- Unit of Laboratory Medicine, Tor Vergata University Hospital, Rome, Italy
| | - Loreta D'Amico
- Unit of Laboratory Medicine, Tor Vergata University Hospital, Rome, Italy
| | - Marta Fogolari
- Unit of Clinical Laboratory Science, University Campus Bio-Medico, Rome, Italy
| | - Eleonora Cella
- Unit of Clinical Laboratory Science, University Campus Bio-Medico, Rome, Italy
| | - Marina De Cesaris
- Unit of Clinical Laboratory Science, University Campus Bio-Medico, Rome, Italy
| | - Fabio De Angelis
- Emergency Department, Tor Vergata University Hospital, Rome, Italy
| | - Massimo Pieri
- Department of Experimental Medicine, University of Tor Vergata, RomeItaly
| | | | - Sergio Bernardini
- Department of Experimental Medicine, University of Tor Vergata, RomeItaly.,Unit of Laboratory Medicine, Tor Vergata University Hospital, Rome, Italy
| | - Marilena Minieri
- Department of Experimental Medicine, University of Tor Vergata, RomeItaly.,Unit of Laboratory Medicine, Tor Vergata University Hospital, Rome, Italy
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Atallah NJ, Panossian VS, Atallah CJ, Schwabe A, Johannes S, Wiemer J, Mansour MK. Mid-regional Proadrenomedullin Biomarker Predicts Coronavirus Disease 2019 Clinical Outcomes: A US-Based Cohort Study. Open Forum Infect Dis 2022; 9:ofac423. [PMID: 36072696 PMCID: PMC9439577 DOI: 10.1093/ofid/ofac423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Indexed: 01/08/2023] Open
Abstract
Background Mid-regional proadrenomedullin (MR-proADM) is a biomarker released following endothelial damage. Studies have shown a correlation in predicting coronavirus disease 2019 (COVID-19) outcomes with MR-proADM levels. Our study aimed to investigate baseline MR-proADM as a predictor of a wider range of clinical outcomes of varying severity in patients admitted with COVID-19, and to compare to other biomarkers. Methods Data from the Boston Area COVID-19 Consortium (BACC) Bay Tocilizumab Trial was used in this study. Patients with biomarker determinations, and not admitted to the intensive care unit (ICU) on admission, were included. MR-proADM cutoff of 0.87 nmol/L was assessed in predicting clinical outcomes. Results Of 182 patients, 11.0% were mechanically ventilated or dead within 28 days. Of patients with MR-proADM >0.87 nmol/L, 21.1% were mechanically ventilated or dead within 28 days, compared with 4.5% of those with MR-proADM ≤0.87 nmol/L (P < .001). The sensitivity, specificity, negative predictive value, and positive predictive value of MR-proADM cutoff of 0.87 nmol/L in predicting mechanical ventilation or death were 75%, 65%, 95%, and 21%, respectively, with an area under the receiver operating characteristic curve of 0.76. On multivariable logistic regression analysis, MR-proADM >0.87 nmol/L was independently associated with mechanical ventilation or death, ICU admission, prolonged hospitalization beyond day 4, and day 4 COVID-19 ordinal scale equal to or worse than day 1. Conclusions MR-proADM functions as a valuable biomarker for the early risk stratification and detection of severe disease progression of patients with COVID-19. In the prediction of death, MR-proADM performed better compared to many other commonly used biomarkers.
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Affiliation(s)
- Natalie J Atallah
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Vahe S Panossian
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Andrej Schwabe
- B·R·A·H·M·S GmbH, part of Thermo Fisher Scientific, Hennigsdorf, Germany
| | - Sascha Johannes
- B·R·A·H·M·S GmbH, part of Thermo Fisher Scientific, Hennigsdorf, Germany
| | - Jan Wiemer
- B·R·A·H·M·S GmbH, part of Thermo Fisher Scientific, Hennigsdorf, Germany
| | - Michael K Mansour
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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Sozio E, Moore NA, Fabris M, Ripoli A, Rumbolo F, Minieri M, Boverio R, Rodríguez Mulero MD, Lainez-Martinez S, Martínez Martínez M, Calvo D, Gregoriano C, Williams R, Brazzi L, Terrinoni A, Callegari T, Hernández Olivo M, Esteban-Torrella P, Calcerrada I, Bernasconi L, Kidd SP, Sbrana F, Miguens I, Gordon K, Visentini D, Legramante JM, Bassi F, Cortes N, Montrucchio G, Di Lecce VN, Lauritano EC, García de Guadiana-Romualdo L, González del Castillo J, Bernal-Morell E, Andaluz-Ojeda D, Schuetz P, Curcio F, Tascini C, Saeed K. Identification of COVID-19 patients at risk of hospital admission and mortality: a European multicentre retrospective analysis of mid-regional pro-adrenomedullin. Respir Res 2022; 23:221. [PMID: 36031619 PMCID: PMC9420187 DOI: 10.1186/s12931-022-02151-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background Mid-Regional pro-Adrenomedullin (MR-proADM) is an inflammatory biomarker that improves the prognostic assessment of patients with sepsis, septic shock and organ failure. Previous studies of MR-proADM have primarily focussed on bacterial infections. A limited number of small and monocentric studies have examined MR-proADM as a prognostic factor in patients infected with SARS-CoV-2, however there is need for multicenter validation. An evaluation of its utility in predicting need for hospitalisation in viral infections was also performed. Methods An observational retrospective analysis of 1861 patients, with SARS-CoV-2 confirmed by RT-qPCR, from 10 hospitals across Europe was performed. Biomarkers, taken upon presentation to Emergency Departments (ED), clinical scores, patient demographics and outcomes were collected. Multiclass random forest classifier models were generated as well as calculation of area under the curve analysis. The primary endpoint was hospital admission with and without death. Results Patients suitable for safe discharge from Emergency Departments could be identified through an MR-proADM value of ≤ 1.02 nmol/L in combination with a CRP (C-Reactive Protein) of ≤ 20.2 mg/L and age ≤ 64, or in combination with a SOFA (Sequential Organ Failure Assessment) score < 2 if MR-proADM was ≤ 0.83 nmol/L regardless of age. Those at an increased risk of mortality could be identified upon presentation to secondary care with an MR-proADM value of > 0.85 nmol/L, in combination with a SOFA score ≥ 2 and LDH > 720 U/L, or in combination with a CRP > 29.26 mg/L and age ≤ 64, when MR-proADM was > 1.02 nmol/L. Conclusions This international study suggests that for patients presenting to the ED with confirmed SARS-CoV-2 infection, MR-proADM in combination with age and CRP or with the patient’s SOFA score could identify patients at low risk where outpatient treatment may be safe.
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Florin TA, Ambroggio L, Brokamp C, Zhang Y, Nylen ES, Rattan M, Crotty E, Belsky MA, Krueger S, Epperson TN, Kachelmeyer A, Ruddy RM, Shah SS. Proadrenomedullin Predicts Severe Disease in Children With Suspected Community-acquired Pneumonia. Clin Infect Dis 2021; 73:e524-e530. [PMID: 32761072 DOI: 10.1093/cid/ciaa1138] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 07/31/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Proadrenomedullin (proADM), a vasodilatory peptide with antimicrobial and anti-inflammatory properties, predicts severe outcomes in adults with community-acquired pneumonia (CAP) to a greater degree than C-reactive protein and procalcitonin. We evaluated the ability of proADM to predict disease severity across a range of clinical outcomes in children with suspected CAP. METHODS We performed a prospective cohort study of children 3 months to 18 years with CAP in the emergency department. Disease severity was defined as mild (discharged home), mild-moderate (hospitalized but not moderate-severe or severe), moderate-severe (eg, hospitalized with supplemental oxygen, broadening of antibiotics, complicated pneumonia), and severe (eg, vasoactive infusions, chest drainage, severe sepsis). Outcomes were examined using proportional odds logistic regression within the cohort with suspected CAP and in a subset with radiographic CAP. RESULTS Among 369 children, median proADM increased with disease severity (mild: median [IQR], 0.53 [0.43-0.73]; mild-moderate: 0.56 [0.45-0.71]; moderate-severe: 0.61 [0.47-0.77]; severe: 0.70 [0.55-1.04] nmol/L) (P = .002). ProADM was significantly associated with increased odds of developing severe outcomes (suspected CAP: OR, 1.68; 95% CI, 1.2-2.36; radiographic CAP: OR, 2.11; 95% CI, 1.36-3.38) adjusted for age, fever duration, antibiotic use, and pathogen. ProADM had an AUC of 0.64 (95% CI, .56-.72) in those with suspected CAP and an AUC of 0.77 (95% CI, .68-.87) in radiographic CAP. CONCLUSIONS ProADM was associated with severe disease and discriminated moderately well children who developed severe disease from those who did not, particularly in radiographic CAP.
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Affiliation(s)
- Todd A Florin
- Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, and Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lilliam Ambroggio
- Sections of Emergency Medicine and Hospital Medicine, Children's Hospital Colorado, Department of Pediatrics, University of Colorado, Aurora, Colorado, USA
| | - Cole Brokamp
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Yin Zhang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Eric S Nylen
- Department of Endocrinology, Veterans Affairs Medical Center, Washington, DC, USA
| | - Mantosh Rattan
- Department of Radiology, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Eric Crotty
- Department of Radiology, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Michael A Belsky
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Sara Krueger
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Thomas N Epperson
- University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Andrea Kachelmeyer
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Richard M Ruddy
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Samir S Shah
- Divisions of Hospital Medicine and Infectious Diseases, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Ewig S, Kolditz M, Pletz M, Altiner A, Albrich W, Drömann D, Flick H, Gatermann S, Krüger S, Nehls W, Panning M, Rademacher J, Rohde G, Rupp J, Schaaf B, Heppner HJ, Krause R, Ott S, Welte T, Witzenrath M. [Management of Adult Community-Acquired Pneumonia and Prevention - Update 2021 - Guideline of the German Respiratory Society (DGP), the Paul-Ehrlich-Society for Chemotherapy (PEG), the German Society for Infectious Diseases (DGI), the German Society of Medical Intensive Care and Emergency Medicine (DGIIN), the German Viological Society (DGV), the Competence Network CAPNETZ, the German College of General Practitioneers and Family Physicians (DEGAM), the German Society for Geriatric Medicine (DGG), the German Palliative Society (DGP), the Austrian Society of Pneumology Society (ÖGP), the Austrian Society for Infectious and Tropical Diseases (ÖGIT), the Swiss Respiratory Society (SGP) and the Swiss Society for Infectious Diseases Society (SSI)]. Pneumologie 2021; 75:665-729. [PMID: 34198346 DOI: 10.1055/a-1497-0693] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The present guideline provides a new and updated concept of the management of adult patients with community-acquired pneumonia. It replaces the previous guideline dating from 2016.The guideline was worked out and agreed on following the standards of methodology of a S3-guideline. This includes a systematic literature search and grading, a structured discussion of recommendations supported by the literature as well as the declaration and assessment of potential conflicts of interests.The guideline has a focus on specific clinical circumstances, an update on severity assessment, and includes recommendations for an individualized selection of antimicrobial treatment.The recommendations aim at the same time at a structured assessment of risk for adverse outcome as well as an early determination of treatment goals in order to reduce mortality in patients with curative treatment goal and to provide palliation for patients with treatment restrictions.
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Affiliation(s)
- S Ewig
- Thoraxzentrum Ruhrgebiet, Kliniken für Pneumologie und Infektiologie, EVK Herne und Augusta-Kranken-Anstalt Bochum
| | - M Kolditz
- Universitätsklinikum Carl-Gustav Carus, Klinik für Innere Medizin 1, Bereich Pneumologie, Dresden
| | - M Pletz
- Universitätsklinikum Jena, Institut für Infektionsmedizin und Krankenhaushygiene, Jena
| | - A Altiner
- Universitätsmedizin Rostock, Institut für Allgemeinmedizin, Rostock
| | - W Albrich
- Kantonsspital St. Gallen, Klinik für Infektiologie/Spitalhygiene
| | - D Drömann
- Universitätsklinikum Schleswig-Holstein, Medizinische Klinik III - Pulmologie, Lübeck
| | - H Flick
- Medizinische Universität Graz, Universitätsklinik für Innere Medizin, Klinische Abteilung für Lungenkrankheiten, Graz
| | - S Gatermann
- Ruhr Universität Bochum, Abteilung für Medizinische Mikrobiologie, Bochum
| | - S Krüger
- Kaiserswerther Diakonie, Florence Nightingale Krankenhaus, Klinik für Pneumologie, Kardiologie und internistische Intensivmedizin, Düsseldorf
| | - W Nehls
- Helios Klinikum Erich von Behring, Klinik für Palliativmedizin und Geriatrie, Berlin
| | - M Panning
- Universitätsklinikum Freiburg, Department für Medizinische Mikrobiologie und Hygiene, Freiburg
| | - J Rademacher
- Medizinische Hochschule Hannover, Klinik für Pneumologie, Hannover
| | - G Rohde
- Universitätsklinikum Frankfurt, Medizinische Klinik I, Pneumologie und Allergologie, Frankfurt/Main
| | - J Rupp
- Universitätsklinikum Schleswig-Holstein, Klinik für Infektiologie und Mikrobiologie, Lübeck
| | - B Schaaf
- Klinikum Dortmund, Klinik für Pneumologie, Infektiologie und internistische Intensivmedizin, Dortmund
| | - H-J Heppner
- Lehrstuhl Geriatrie Universität Witten/Herdecke, Helios Klinikum Schwelm, Klinik für Geriatrie, Schwelm
| | - R Krause
- Medizinische Universität Graz, Universitätsklinik für Innere Medizin, Klinische Abteilung für Infektiologie, Graz
| | - S Ott
- St. Claraspital Basel, Pneumologie, Basel, und Universitätsklinik für Pneumologie, Universitätsspital Bern (Inselspital) und Universität Bern
| | - T Welte
- Medizinische Hochschule Hannover, Klinik für Pneumologie, Hannover
| | - M Witzenrath
- Charité, Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Infektiologie und Pneumologie, Berlin
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Gonzalez Del Castillo J, Clemente-Callejo C, Llopis F, Irimia A, Oltra-Hostalet F, Rechner C, Schwabe A, Fernandez-Rodriguez V, Sánchez-Mora C, Giol-Amich J, Prieto-García B, Bardés-Robles I, Ortega-de Heredia MD, García-Lamberechts EJ, Navarro-Bustos C. Midregional proadrenomedullin safely reduces hospitalization in a low severity cohort with infections in the ED: a randomized controlled multi-centre interventional pilot study. Eur J Intern Med 2021; 88:104-113. [PMID: 33906810 DOI: 10.1016/j.ejim.2021.03.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/26/2021] [Accepted: 03/27/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The midregional fragment of proadrenomedullin (MR-proADM) is known to provide accurate short-, mid- and long term prognostic information in the triage and multi-dimensional risk assessment of patients in the emergency department (ED). In two independent observational cohorts MR-proADM values identified low disease severity patients without risk of disease progression in the ED with no 28 days mortality that wouldn´t require hospitalization. In this interventional study we want to show that the combination of an MR-proADM algorithm with clinical assessment is able to identify low risk patients not requiring hospitalization to safely reduce the number of hospital admissions. METHODS A randomized-controlled interventional multicenter study in 4 EDs in Spain. The study protocol was approved by Ethics Committees. Control arm patients received Standard Care. MR-proADM guided arm patients with low MR-proADM value (≤0.87 nmol/L) were treated as out-patients, with high MR-proADM value (>0.87 nmol/L) were hospitalized. The hospitalization rate was compared between the study arms. RESULTS Two hundred patients with suspicion of infection were enrolled. In the MR-proADM guided arm the hospital admission rate in the intention-to-treat (ITT) population was 17% lower than in the control arm (40.6% vs. 57.6%, p=0.024) and 20% lower in the per protocol (PP) population (37.2% vs. 57.6%, p=0.009). No deaths of out-patients and no significant difference for the safety endpoints readmission and representation rates were observed. The readmission rate was only slightly higher in the MR-proADM guided arm compared to the control arm (PP population: at 14 days 9.3% vs. 7.1%, difference 2.1% (95% CI: -11.0% to 15.2%); and at 28 days 11.1% vs. 9.5%, difference 1.6% (95% CI: -12.2% to 15.4%)). The rate of 28 days representation was slightly lower in the MR-proADM guided arm compared to the control arm (20.4% vs. 26.2%, difference -5.8% (95% CI: -25.0% to 13.4%); PP population). CONCLUSIONS Implementing a MR-proADM algorithm optimizes ED workflows efficiently and sustainably. Hospitals can highly benefit from a reduced rate of hospitalizations by 20% using MR-proADM. The safety in the MR-proADM guided study arm was similar to the Standard Care arm. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT03770533.
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Affiliation(s)
- Juan Gonzalez Del Castillo
- Emergency Department, Instituto de Investigación Sanitaria (IdISSC), Hospital Clínico San Carlos, Madrid, Spain.
| | | | - Ferran Llopis
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Andreea Irimia
- Emergency Department, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Hospital Universitario Central de Asturias, Oviedo, Spain.
| | | | - Cindy Rechner
- Thermo Fisher Scientific, BRAHMS GmbH, Hennigsdorf, Germany.
| | - Andrej Schwabe
- Thermo Fisher Scientific, BRAHMS GmbH, Hennigsdorf, Germany.
| | - Verónica Fernandez-Rodriguez
- Emergency Department, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Hospital Universitario Central de Asturias, Oviedo, Spain.
| | - Catalina Sánchez-Mora
- Clinical Biochemistry Department. Hospital Universitario Virgen de la Macarena, Seville, Spain.
| | - Jordi Giol-Amich
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Belén Prieto-García
- Clinical Biochemistry Department, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Hospital Universitario Central de Asturias, Oviedo, Spain.
| | - Ignasi Bardés-Robles
- Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
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9
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Van Oers J, Krabbe J, Kemna E, Kluiters Y, Vos P, De Lange D, Girbes A, Beishuizen A. Mid-Regional Proadrenomedullin and Mid-Regional Proatrial Natriuretic Peptide Clearance Predicts Poor Outcomes Better Than Single Baseline Measurements in Critically Ill Patients With Pneumonia: A Retrospective Cohort Study. Cureus 2021; 13:e15285. [PMID: 34221750 PMCID: PMC8237920 DOI: 10.7759/cureus.15285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2021] [Indexed: 12/28/2022] Open
Abstract
Background We assessed the ability of baseline and serial measurements of mid-regional proadrenomedullin (MR-proADM) and mid-regional proatrial natriuretic peptide (MR-proANP) to predict 28-day mortality in critically ill patients with pneumonia compared with Acute Physiological and Chronic Health Evaluation IV (APACHE IV) model and Sequential Organ Failure Assessment (SOFA) score. Methodology Biomarkers were collected for the first five days in this retrospective observational cohort study. Biomarker clearance (as a percentage) was presented as biomarker decline in five days. We investigated the relationship between biomarkers and mortality in a multivariable Cox regression model. APACHE IV and SOFA were calculated after 24 hours from intensive care unit admission. Results In 153 critically ill patients with pneumonia, 28-day mortality was 26.8%. Values of baseline MR-proADM, MR-proANP, and APACHE IV were significantly higher in 28-day nonsurvivors, but not significantly different for SOFA score. Baseline MR-proADM and MR-proANP, APACHE IV, and SOFA had a low area under the curve in receiver operating characteristics (ROC) curves. No optimal cut-off points could be calculated. Biomarkers and severity scores were divided into tertiles. The highest tertiles baseline MR-proADM and MR-proANP were not significant predictors for 28-day mortality in a multivariable model with age and APACHE IV. SOFA was not a significant predictor in univariable analysis. Clearances of MR-proADM and MR-proANP were significantly higher in 28-day survivors. MR-proADM and MR-proANP clearances had similar low accuracy to identify nonsurvivors in ROC curves and were divided into tertiles. Low clearances of MR-proADM and MR-proANP (first tertiles) were significant predictors for 28-day mortality (hazard ratio [HR]: 2.38; 95% confidence interval [CI]: 1.21-4.70; p = 0.013 and HR: 2.27; 95% CI: 1.16-4.46; p = 0.017) in a model with age and APACHE IV. Conclusions MR-proADM and MR-proANP clearance performed better in predicting 28-day mortality in a model with age and APACHE IV compared with single baseline measurements in a mixed population of critically ill with pneumonia.
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Affiliation(s)
- Jos Van Oers
- Department of Intensive Care Medicine, Elisabeth-TweeSteden Ziekenhuis, Tilburg, NLD
| | - Johannes Krabbe
- Department of Clinical Chemistry, Medisch Spectrum Twente, Enschede, NLD
| | - Evelien Kemna
- Department of Clinical Chemistry, Medisch Spectrum Twente, Enschede, NLD
| | - Yvette Kluiters
- Department of Clinical Chemistry, Elisabeth-TweeSteden Ziekenhuis, Tilburg, NLD
| | - Piet Vos
- Department of Intensive Care Medicine, Elisabeth-TweeSteden Ziekenhuis, Tilburg, NLD
| | - Dylan De Lange
- Department of Intensive Care Medicine, University Medical Centre Utrecht, University Utrecht, Utrecht, NLD
| | - Armand Girbes
- Department of Intensive Care Medicine, Amsterdam University Medical Center, Medical Centres, VU University Medical Centre, Amsterdam, NLD
| | - Albertus Beishuizen
- Department of Intensive Care Medicine, Medisch Spectrum Twente, Enschede, NLD
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10
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Clofent D, Álvarez A, Traversi L, Culebras M, Loor K, Polverino E. Comorbidities and mortality risk factors for patients with bronchiectasis. Expert Rev Respir Med 2021; 15:623-634. [PMID: 33583300 DOI: 10.1080/17476348.2021.1886084] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Introduction: Comorbidities in patients with bronchiectasis are common and have a significant impact on clinical outcomes, contributing to lower quality of life, lung function, and exacerbation frequency. At least 13 comorbidities have been associated with a higher risk of mortality in bronchiectasis patients. Nonetheless, the kind of relationship between bronchiectasis and comorbidities is heterogeneous and poorly understood.Areas covered: different biological mechanisms leading to bronchiectasis could have a role in the development of the associated comorbidities. Some comorbidities could have a causal relationship with bronchiectasis, possibly through a variable degree of systemic inflammation, such as in rheumatic disorders and bowel inflammatory diseases. Other comorbidities, such as COPD or asthma, could be associated through airway inflammation and there is an uncertain cause-effect relationship. Finally, shared risk factors could link different comorbidities to bronchiectasis such as in the case of cardiovascular diseases, where the known link between chronic systemic inflammation and pulmonary infection could play a significant role.Expert opinion: Although different tools have been developed to assess the role of comorbidities in bronchiectasis , we believe that the implementation of current strategies to manage them is absolutely necessary and could significantly improve long-term prognosis in patients with bronchiectasis.
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Affiliation(s)
- David Clofent
- Vall d'Hebron Institute of Research (VHIR) - Respiratory Disease Department, Hospital Universitari Vall d'Hebron (HUVH) Passeig Vall d'Hebron, 119-129, Barcelona, Spain.,Respiratory Diseases, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
| | - Antonio Álvarez
- Vall d'Hebron Institute of Research (VHIR) - Respiratory Disease Department, Hospital Universitari Vall d'Hebron (HUVH) Passeig Vall d'Hebron, 119-129, Barcelona, Spain.,Respiratory Diseases, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
| | - Letizia Traversi
- Department of Medicine and Surgery, Respiratory Diseases, Università dell'Insubria, Varese, Italy
| | - Mario Culebras
- Vall d'Hebron Institute of Research (VHIR) - Respiratory Disease Department, Hospital Universitari Vall d'Hebron (HUVH) Passeig Vall d'Hebron, 119-129, Barcelona, Spain.,Respiratory Diseases, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
| | - Karina Loor
- Vall d'Hebron Institute of Research (VHIR) - Respiratory Disease Department, Hospital Universitari Vall d'Hebron (HUVH) Passeig Vall d'Hebron, 119-129, Barcelona, Spain.,Respiratory Diseases, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
| | - Eva Polverino
- Vall d'Hebron Institute of Research (VHIR) - Respiratory Disease Department, Hospital Universitari Vall d'Hebron (HUVH) Passeig Vall d'Hebron, 119-129, Barcelona, Spain.,Respiratory Diseases, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
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11
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Haag E, Gregoriano C, Molitor A, Kloter M, Kutz A, Mueller B, Schuetz P. Does mid-regional pro-adrenomedullin (MR-proADM) improve the sequential organ failure assessment-score (SOFA score) for mortality-prediction in patients with acute infections? Results of a prospective observational study. Clin Chem Lab Med 2021; 59:1165-1176. [PMID: 33554514 DOI: 10.1515/cclm-2020-1566] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/27/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Risk stratification in patients with infection is usually based on the Sequential Organ Failure Assessment-Score (SOFA score). Our aim was to investigate whether the vasoactive peptide mid-regional pro-adrenomedullin (MR-proADM) improves the predictive value of the SOFA score for 30-day mortality in patients with acute infection presenting to the emergency department (ED). METHODS This secondary analysis of the prospective observational TRIAGE study included 657 patients with infection. The SOFA score, MR-proADM, and traditional inflammation markers were all measured at time of admission. Associations of admission parameters and 30-day mortality were investigated by measures of logistic regression, discrimination analyses, net reclassification index (NRI), and integrated discrimination index (IDI). RESULTS MR-proADM values were higher in non-survivors compared with survivors (4.5±3.5 nmol/L vs. 1.7 ± 1.8 nmol/L) with an adjusted odds ratio of 26.6 (95% CI 3.92 to 180.61, p=0.001) per 1 nmol/L increase in admission MR-proADM levels and an area under the receiver operator curve (AUC) of 0.86. While the SOFA score alone revealed an AUC of 0.81, adding MR-proADM further improved discrimination (AUC 0.87) and classification within predefined risk categories (NRI 0.075, p-value <0.05). An admission MR-proADM threshold of 1.75 nmol/L provided the best prognostic accuracy for 30-day mortality; with a sensitivity of 81% and a specificity of 75%, and a negative predictive value of 98%. CONCLUSIONS MR-proADM improved the mortality risk stratification in patients with infection presenting to the ED beyond SOFA score alone and may further improve initial therapeutic site-of-care decisions. TRIAL REGISTRATION ClinicalTrials.gov NCT01768494. Registered January 15, 2013.
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Affiliation(s)
- Ellen Haag
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Claudia Gregoriano
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Alexandra Molitor
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Milena Kloter
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Alexander Kutz
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Beat Mueller
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Philipp Schuetz
- Medical University Department, Division of General Internal and Emergency Medicine, Kantonsspital Aarau, Aarau, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
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12
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Gregoriano C, Koch D, Kutz A, Haubitz S, Conen A, Bernasconi L, Hammerer-Lercher A, Saeed K, Mueller B, Schuetz P. The vasoactive peptide MR-pro-adrenomedullin in COVID-19 patients: an observational study. Clin Chem Lab Med 2021; 59:995-1004. [PMID: 33554516 DOI: 10.1515/cclm-2020-1295] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 12/15/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Midregional pro-adrenomedullin (MR-proADM) is a vasoactive peptide with key roles in reducing vascular hyperpermeability and thereby improving endothelial stability during infection. While MR-proADM is useful for risk stratification in patients with sepsis, clinical data about prediction accuracy in patients with severe acute respiratory syndrome coronavirus 2 disease (COVID-19) is currently missing. METHODS We included consecutively adult patients hospitalized for confirmed COVID-19 at a tertiary care center in Switzerland between February and April 2020. We investigated the association of MR-proADM levels with in-hospital mortality in logistic regression and discrimination analyses. RESULTS Of 89 included COVID-19 patients, 19% (n=17) died while in the hospital. Median admission MR-proADM levels (nmol/L) were increased almost 1.5-fold increased in non-survivors compared to survivors (1.3 [interquartile range IQR 1.1-2.3]) vs. 0.8 [IQR 0.7-1.1]) and showed good discrimination (area under the curve 0.78). An increase of 1 nmol/L of admission MR-proADM was independently associated with a more than fivefold increase in in-hospital mortality (adjusted odds ratio of 5.5, 95% confidence interval 1.4-21.4, p=0.015). An admission MR-proADM threshold of 0.93 nmol/L showed the best prognostic accuracy for in-hospital mortality with a sensitivity of 93%, a specificity of 60% and a negative predictive value of 97%. Kinetics of follow-up MR-proADM provided further prognostic information for in-hospital treatment. CONCLUSIONS Increased levels of MR-proADM on admission and during hospital stay were independently associated with in-hospital mortality and may allow a better risk stratification, and particularly rule-out of fatal outcome, in COVID-19 patients.
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Affiliation(s)
- Claudia Gregoriano
- Medical University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Daniel Koch
- Medical University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Alexander Kutz
- Medical University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Sebastian Haubitz
- Medical University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland.,Department of Infectious Diseases and Hospital Hygiene, Kantonsspital Aarau, Aarau, Switzerland
| | - Anna Conen
- Department of Infectious Diseases and Hospital Hygiene, Kantonsspital Aarau, Aarau, Switzerland.,Medical Faculty, University of Basel, Basel, Switzerland
| | - Luca Bernasconi
- Institute of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | | | - Kordo Saeed
- Microbiology Innovation and Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,University of Southampton, School of Medicine Tremona Road Southampton, Southampton, UK
| | - Beat Mueller
- Medical University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland.,Medical Faculty, University of Basel, Basel, Switzerland
| | - Philipp Schuetz
- Medical University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland.,Medical Faculty, University of Basel, Basel, Switzerland
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13
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Song Y, Sun W, Dai D, Liu Y, Li Z, Tian Z, Liu X. Prediction value of procalcitonin combining CURB-65 for 90-day mortality in community-acquired pneumonia. Expert Rev Respir Med 2020; 15:689-696. [PMID: 33336607 DOI: 10.1080/17476348.2021.1865810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Due to its high mortality rate, immediate and reliable severity assessment and accurate prediction of prognosis at hospital admission is critical for the management of community-acquired pneumonia (CAP) patients.Methods: Consecutive patients with primary diagnosis of CAP and hospitalized at our hospital from January 2013 to December 2015 were screened for this retrospective study. Demographic information, clinical and laboratory examination, severity model scoring, and 90-day outcomes were studied. Area under the curve (AUC) of receiver operating characteristic curve (ROC) was analyzed to compare the predictive value of different prognostic scoring methods.Results: 2099 CAP patients with a median age of 60 (IQR 44.0-73.0) years-old were included in this study. Median length of stay was 10 days (IQR 8.0-13.0). The all-cause 90-day mortality was found in 2.19% (46/2099) of all patients. PCT was identified as an independent predictor for the prognosis of CAP patients. CURB-65 in combination with PCT outperformed other predictive methods in 90-day mortality with the optimal AUC of 0.900 and Youden's Index of 0.706.Conclusions: PCT is a good marker for the assessment of severity and 90-day mortality of CAP patients. The combination of PCT and CURB-65 was more accurate than other prognostic models in predicting 90-day mortality.
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Affiliation(s)
- Yu Song
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Wenxue Sun
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Deyu Dai
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yue Liu
- The Respiratory Department, Cang Zhou People's Hospital, China
| | - Zhongyi Li
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhennan Tian
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xiaomin Liu
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, China
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14
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Öner Ö, Deveci F, Telo S, Kuluöztürk M, Balin M. MR-proADM and MR-proANP levels in patients with acute pulmonary embolism. J Med Biochem 2020; 39:328-335. [PMID: 33269021 PMCID: PMC7682857 DOI: 10.2478/jomb-2019-0049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/07/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The aim of this study was to determine levels of Mid-regional Pro-adrenomedullin (MR-proADM) and Mid-regional Pro-atrial Natriuretic Peptide (MR-proANP) in patients with acute pulmonary embolism (PE), the relationship between these parameters and the risk classification in addition to determining the relationship between 1and 3month mortality. METHODS 82 PE patients and 50 healthy control subjects were included in the study. Blood samples for Mr-proANP and Mr-proADM were obtained from the subjects prior to the treatment. Risk stratification was determined according to sPESI (Simplified Pulmonary Embolism Severity Index). Following these initial measurements, cases with PE were assessed in terms of all causative and PE related mortalities. RESULTS The mean serum Mr-proANP and Mr-proADM levels in acute PE patients were found to be statistically higher compared to the control group (p < 0.001, p < 0.01; respectively) and statistically significantly higher in high-risk patients than low-risk patients (p < 0.01, p < 0.05; respectively). No statistical difference was determined in high-risk patients in case of sPESI compared to low-risk patients while hospital mortality rates were higher. It was determined that the hospital mortality rate in cases with Mr-proANP ≥ 123.30 pmol/L and the total 3-month mortality rate in cases with Mr-proADM ≥ 152.2 pg/mL showed a statistically significant increase. CONCLUSIONS This study showed that Mr-proANP and MRproADM may be an important biochemical marker for determining high-risk cases and predicting the mortality in PE patients and we believe that these results should be supported by further and extensive studies.
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Affiliation(s)
- Önsel Öner
- Firat University, School of Medicine, Department of Pulmonary Medicine, Elazig, Turkey
| | - Figen Deveci
- Firat University, School of Medicine, Department of Pulmonary Medicine, Elazig, Turkey
| | - Selda Telo
- Firat University, School of Medicine, Department of Biochemistry, Elazig, Turkey
| | - Mutlu Kuluöztürk
- Firat University, School of Medicine, Department of Pulmonary Medicine, Elazig, Turkey
| | - Mehmet Balin
- Firat University, School of Medicine, Department of Cardiology, Elazig, Turkey
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15
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Méndez R, Aldás I, Menéndez R. Biomarkers in Community-Acquired Pneumonia (Cardiac and Non-Cardiac). J Clin Med 2020; 9:E549. [PMID: 32085380 PMCID: PMC7073979 DOI: 10.3390/jcm9020549] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/07/2020] [Accepted: 02/10/2020] [Indexed: 12/18/2022] Open
Abstract
Community-acquired pneumonia (CAP) remains the first cause of morbidity and mortality worldwide due to infection. Several aspects such as severity and host response are related to its clinical course and outcome. Beyond the acute implications that the infection provokes in the host, pneumonia also has long-term negative consequences. Among them, cardiovascular complications and mortality are the most outstanding. Therefore, an adequate recognition and stratification of the risk of complications and mortality is crucial. Many biomarkers have been studied for these reasons, considering that each biomarker mirrors a different aspect. Moreover, the clinical application of many of them is still being deliberated because of their limitations and the heterogeneity of the disease. In this review, we examine some of the most relevant biomarkers that we have classified as cardiac and non-cardiac. We discuss some classic biomarkers and others that are considered novel biomarkers, which are mainly involved in cardiovascular risk.
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Affiliation(s)
- Raúl Méndez
- Pneumology Department, Hospital Universitario y Politécnico La Fe/Instituto de Investigación Sanitaria (IIS) La Fe, 46026 Valencia, Spain; Pneumology Department, Hospital Universitario y Politécnico La Fe, Avda, Fernando Abril Martorell 106, 46026 Valencia, Spain;
| | - Irene Aldás
- University of Valencia, Medicine Faculty, 46026 Valencia, Spain;
- Pneumology Department, Hospital Germans Trias i Pujol, 08916 Badalona, Spain
| | - Rosario Menéndez
- Pneumology Department, Hospital Universitario y Politécnico La Fe/Instituto de Investigación Sanitaria (IIS) La Fe, 46026 Valencia, Spain; Pneumology Department, Hospital Universitario y Politécnico La Fe, Avda, Fernando Abril Martorell 106, 46026 Valencia, Spain;
- University of Valencia, Medicine Faculty, 46026 Valencia, Spain;
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), 28029 Madrid, Spain
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16
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Rudnov VA, Moldovanov AV, Astafieva MN, Perevalova EY. The clinical significance of proadrenomedulin level in blood in sepsis patients. MESSENGER OF ANESTHESIOLOGY AND RESUSCITATION 2019. [DOI: 10.21292/2078-5658-2019-16-5-36-42] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- V. A. Rudnov
- Ural State Medical University; City Clinical Hospital no. 40
| | | | - M. N. Astafieva
- Ural State Medical University; City Clinical Hospital no. 40
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17
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Bobillo-Perez S, Jordan I, Corniero P, Balaguer M, Sole-Ribalta A, Esteban ME, Esteban E, Cambra FJ. Prognostic value of biomarkers after cardiopulmonary bypass in pediatrics: The prospective PANCAP study. PLoS One 2019; 14:e0215690. [PMID: 31206538 PMCID: PMC6576774 DOI: 10.1371/journal.pone.0215690] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 04/05/2019] [Indexed: 01/03/2023] Open
Abstract
Objective To assess the usefulness of procalcitonin, pro-adrenomedullin and pro-atrial natriuretic peptide as predictors of need for mechanical ventilation and postoperative complications (need for inotropic support and bacterial infection) in critically ill pediatric patients after cardiopulmonary bypass. Design A prospective, observational study Setting Pediatric intensive care unit. Patients Patients under 18 years old admitted after cardiopulmonary bypass. Measuraments and main results Serum levels of procalcitonin, pro-adrenomedullin and pro-atrial natriuretic peptide were determined immediately after bypass and at 24–36 hours. Their values were correlated with the need for mechanical ventilation, inotropic support and bacterial infection. One hundred eleven patients were recruited. Septal defects (30.6%) and cardiac valve disease (17.1%) were the most frequent pathologies. 40.7% required mechanical ventilation, 94.6% inotropic support and 15.3% presented invasive bacterial infections. Pro-adrenomedullin and pro-atrial natriuretic peptide showed significant high values in patients needing mechanical ventilation. Cut-off values higher than 1.22 nmol/L and 215.3 pmol/L, respectively for each biomarker, may indicate need for mechanical ventilation with an AUC of 0.721 and 0.746 at admission and 0.738 and 0.753 at 24–36 hours, respectively but without statistical differences. Pro-adrenomedullin and procalcitonin showed statistically significant high values in patients with bacterial infections. Conclusions After bypass, pro-adrenomedullin and pro-atrial natriuretic peptide are suitable biomarkers to predict the need for mechanical ventilation. Physicians should be alert if the values of these markers are high so as not to progress to early extubation. Procalcitonin is useful for predicting bacterial infection. This is a preliminary study and more clinical studies should be done to confirm the value of pro-adrenomedullin and pro-atrial natriuretic peptide as biomarkers after cardiopulmonary bypass.
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Affiliation(s)
- Sara Bobillo-Perez
- Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Pediatric Intensive Care Research Group, Institut Recerca Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Iolanda Jordan
- Pediatric Intensive Care Unit, Sant Joan de Déu Hospital, Pediatric Intensive Care Research Group, Institut Recerca Hospital Sant Joan de Déu, CIBERESP, Barcelona, Spain
- * E-mail:
| | - Patricia Corniero
- Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Monica Balaguer
- Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Anna Sole-Ribalta
- Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Maria Esther Esteban
- Section of Zoology and Biological Anthropology, Department of Evolutionary Biology, Ecology and Environmental Sciences, Faculty of Biology, Universitat de Barcelona, Barcelona, Spain
- Institut de Recerca de la Biodiversitat (IRBio), Universitat de Barcelona, Barcelona, Spain
| | - Elisabeth Esteban
- Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Barcelona, Spain
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18
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Graziadio S, O’Leary RA, Stocken DD, Power M, Allen AJ, Simpson AJ, Price DA. Can mid-regional pro-adrenomedullin (MR-proADM) increase the prognostic accuracy of NEWS in predicting deterioration in patients admitted to hospital with mild to moderately severe illness? A prospective single-centre observational study. BMJ Open 2019; 8:e020337. [PMID: 30798282 PMCID: PMC6278796 DOI: 10.1136/bmjopen-2017-020337] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To assess the value added to the National Early Warning Score (NEWS) by mid-regional pro-adrenomedullin (MR-proADM) blood level in predicting deterioration in mild to moderately ill people. DESIGN Prospective observational study. SETTING The Medical Admissions Suite of the Royal Victoria Infirmary, Newcastle. PARTICIPANTS 300 adults with NEWS between 2 and 5 on admission. Exclusion criteria included receiving palliative care, or admitted for social reasons or self-harming. Patients were enrolled between September and December 2015, and followed up for 30 days after discharge. OUTCOME MEASURE The primary outcome measure was the proportion of patients who, within 72 hours, had an acuity increase, defined as any combination of an increase of at least 2 in the NEWS; transfer to a higher-dependency bed or monitored area; death; or for those discharged from hospital, readmission for medical reasons. RESULTS NEWS and MR-proADM together predicted acuity increase more accurately than NEWS alone, increasing the area under the curve (AUC) to 0.61 (95% CI 0.54 to 0.69) from 0.55 (95% CI 0.48 to 0.62). When the confounding effects of presence of chronic obstructive pulmonary disease or heart failure and interaction with MR-proADM were included, the prognostic accuracy further increased the AUC to 0.69 (95% CI 0.63 to 0.76). CONCLUSIONS MR-proADM is potentially a clinically useful biomarker for deterioration in patients admitted to hospital with a mild to moderately severe acute illness, that is, with NEWS between 2 and 5. As a growing number of National Health Service hospitals are routinely recording the NEWS on their clinical information systems, further research should assess the practicality and use of developing a decision aid based on admission NEWS, MR-proADM level, and possibly other clinical data and other biomarkers that could further improve prognostic accuracy.
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Affiliation(s)
- Sara Graziadio
- NIHR Newcastle In Vitro Diagnostics Co-operative, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, UK
| | - Rachel Amie O’Leary
- NIHR Newcastle In Vitro Diagnostics Co-operative, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, UK
| | - Deborah D Stocken
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
- Department of Infectious Diseases, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Michael Power
- NIHR Newcastle In Vitro Diagnostics Co-operative, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, UK
| | - A Joy Allen
- NIHR Newcastle In Vitro Diagnostics Co-operative, Newcastle University, Newcastle upon Tyne, UK
| | - A John Simpson
- NIHR Newcastle In Vitro Diagnostics Co-operative, Newcastle University, Newcastle upon Tyne, UK
| | - David Ashley Price
- NIHR Newcastle In Vitro Diagnostics Co-operative, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, UK
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19
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Saeed K, Wilson DC, Bloos F, Schuetz P, van der Does Y, Melander O, Hausfater P, Legramante JM, Claessens YE, Amin D, Rosenqvist M, White G, Mueller B, Limper M, Callejo CC, Brandi A, Macchi MA, Cortes N, Kutz A, Patka P, Yañez MC, Bernardini S, Beau N, Dryden M, van Gorp ECM, Minieri M, Chan L, Rood PPM, Del Castillo JG. The early identification of disease progression in patients with suspected infection presenting to the emergency department: a multi-centre derivation and validation study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:40. [PMID: 30736862 PMCID: PMC6368690 DOI: 10.1186/s13054-019-2329-5] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 01/18/2019] [Indexed: 12/16/2022]
Abstract
Background There is a lack of validated tools to assess potential disease progression and hospitalisation decisions in patients presenting to the emergency department (ED) with a suspected infection. This study aimed to identify suitable blood biomarkers (MR-proADM, PCT, lactate and CRP) or clinical scores (SIRS, SOFA, qSOFA, NEWS and CRB-65) to fulfil this unmet clinical need. Methods An observational derivation patient cohort validated by an independent secondary analysis across nine EDs. Logistic and Cox regression, area under the receiver operating characteristic (AUROC) and Kaplan-Meier curves were used to assess performance. Disease progression was identified using a composite endpoint of 28-day mortality, ICU admission and hospitalisation > 10 days. Results One thousand one hundred seventy-five derivation and 896 validation patients were analysed with respective 28-day mortality rates of 7.1% and 5.0%, and hospitalisation rates of 77.9% and 76.2%. MR-proADM showed greatest accuracy in predicting 28-day mortality and hospitalisation requirement across both cohorts. Patient subgroups with high MR-proADM concentrations (≥ 1.54 nmol/L) and low biomarker (PCT < 0.25 ng/mL, lactate < 2.0 mmol/L or CRP < 67 mg/L) or clinical score (SOFA < 2 points, qSOFA < 2 points, NEWS < 4 points or CRB-65 < 2 points) values were characterised by a significantly longer length of hospitalisation (p < 0.001), rate of ICU admission (p < 0.001), elevated mortality risk (e.g. SOFA, qSOFA and NEWS HR [95%CI], 45.5 [10.0–207.6], 23.4 [11.1–49.3] and 32.6 [9.4–113.6], respectively) and a greater number of disease progression events (p < 0.001), compared to similar subgroups with low MR-proADM concentrations (< 1.54 nmol/L). Increased out-patient treatment across both cohorts could be facilitated using a derivation-derived MR-proADM cut-off of < 0.87 nmol/L (15.0% and 16.6%), with decreased readmission rates and no mortalities. Conclusions In patients presenting to the ED with a suspected infection, the blood biomarker MR-proADM could most accurately identify the likelihood of further disease progression. Incorporation into an early sepsis management protocol may therefore aid rapid decision-making in order to either initiate, escalate or intensify early treatment strategies, or identify patients suitable for safe out-patient treatment. Electronic supplementary material The online version of this article (10.1186/s13054-019-2329-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kordo Saeed
- Department of Microbiology, Hampshire Hospitals NHS Foundation Trust, Winchester and Basingstoke, UK. .,University of Southampton, School of Medicine, Southampton, UK.
| | | | - Frank Bloos
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany.,Center for Sepsis Control & Care (CSCC), Jena University Hospital, Jena, Germany
| | - Philipp Schuetz
- Division of General and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Switzerland.,Medical Faculty of the University of Basel, Basel, Switzerland
| | - Yuri van der Does
- Department of Emergency Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Olle Melander
- Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden.,Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Pierre Hausfater
- Emergency Department hôpital Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris and Sorbonne Universités GRC-14 BIOSFAST and INSERM UMR-S 1166, Paris, France
| | - Jacopo M Legramante
- Emergency Department, Policlinico Tor Vergata, Rome, Italy.,Department of Medical Systems, Universita di Tor Vergata, Rome, Italy
| | - Yann-Erick Claessens
- Department of Emergency Medicine, Monaco Princess Grace Hospital, Monaco, France
| | - Deveendra Amin
- Department of Critical Care, Morton Plant Hospital, 300 Pinellas Street, Clearwater, FL, 33756, USA
| | - Mari Rosenqvist
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden.,Infectious Disease Unit, Skåne University Hospital, Malmö, Sweden
| | - Graham White
- Department of Blood Sciences, Hampshire Hospitals NHS Foundation Trust, Winchester and Basingstoke, UK
| | - Beat Mueller
- Division of General and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Switzerland.,Medical Faculty of the University of Basel, Basel, Switzerland
| | - Maarten Limper
- Department of Rheumatology and Clinical Immunology, University Medical Center, Utrecht University, Utrecht, Netherlands
| | | | | | - Marc-Alexis Macchi
- Department of Emergency Medicine, Monaco Princess Grace Hospital, Monaco, France
| | - Nicholas Cortes
- Department of Microbiology, Hampshire Hospitals NHS Foundation Trust, Winchester and Basingstoke, UK.,University of Southampton, School of Medicine, Southampton, UK.,Gibraltar Health Authority, St Bernard's Hospital, Gibraltar, Spain
| | - Alexander Kutz
- Division of General and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Switzerland
| | - Peter Patka
- Department of Emergency Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - Sergio Bernardini
- Department of Laboratory Medicine, Policlinico Tor Vergata, Rome, Italy.,Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Nathalie Beau
- Department of Emergency Medicine, Monaco Princess Grace Hospital, Monaco, France
| | - Matthew Dryden
- Department of Microbiology, Hampshire Hospitals NHS Foundation Trust, Winchester and Basingstoke, UK.,University of Southampton, School of Medicine, Southampton, UK.,Rare and Imported Pathogen Laboratories, Public Health England, Porton Down, UK
| | - Eric C M van Gorp
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, Netherlands.,Department of Viroscience, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Marilena Minieri
- Department of Laboratory Medicine, Policlinico Tor Vergata, Rome, Italy
| | - Louisa Chan
- Department of accident and emergency, Hampshire Hospitals NHS Foundation Trust, Winchester and Basingstoke, UK
| | - Pleunie P M Rood
- Department of Emergency Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Juan Gonzalez Del Castillo
- Emergency Department, Instituto de Investigación Sanitaria (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
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20
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Montini L, Antonelli M. Biomarkers in sepsis: towards precision medicine for the prevention of adverse outcomes. Minerva Anestesiol 2018; 85:333-335. [PMID: 30484300 DOI: 10.23736/s0375-9393.18.13260-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Luca Montini
- Institute of Anesthesia and Resuscitation, A. Gemelli University Hospital and Institute for Research and Care, Rome, Italy - .,Sacred Heart Catholic University, Rome, Italy -
| | - Massimo Antonelli
- Institute of Anesthesia and Resuscitation, A. Gemelli University Hospital and Institute for Research and Care, Rome, Italy.,Sacred Heart Catholic University, Rome, Italy
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21
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Elke G, Bloos F, Wilson DC, Brunkhorst FM, Briegel J, Reinhart K, Loeffler M, Kluge S, Nierhaus A, Jaschinski U, Moerer O, Weyland A, Meybohm P. The use of mid-regional proadrenomedullin to identify disease severity and treatment response to sepsis - a secondary analysis of a large randomised controlled trial. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:79. [PMID: 29562917 PMCID: PMC5863464 DOI: 10.1186/s13054-018-2001-5] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 02/19/2018] [Indexed: 02/08/2023]
Abstract
Background This study assessed the ability of mid-regional proadrenomedullin (MR-proADM) in comparison to conventional biomarkers (procalcitonin (PCT), lactate, C-reactive protein) and clinical scores to identify disease severity in patients with sepsis. Methods This is a secondary analysis of a randomised controlled trial in patients with severe sepsis or septic shock across 33 German intensive care units. The association between biomarkers and clinical scores with mortality was assessed by Cox regression analysis, area under the receiver operating characteristic and Kaplan-Meier curves. Patients were stratified into three severity groups (low, intermediate, high) for all biomarkers and scores based on cutoffs with either a 90% sensitivity or specificity. Results 1089 patients with a 28-day mortality rate of 26.9% were analysed. According to the Sepsis-3 definition, 41.2% and 58.8% fulfilled the criteria for sepsis and septic shock, with respective mortality rates of 20.0% and 32.1%. MR-proADM had the strongest association with mortality across all Sepsis-1 and Sepsis-3 subgroups and could facilitate a more accurate classification of low (e.g. MR-proADM vs. SOFA: N = 265 vs. 232; 9.8% vs. 13.8% mortality) and high (e.g. MR-proADM vs. SOFA: N = 161 vs. 155; 55.9% vs. 41.3% mortality) disease severity. Patients with decreasing PCT concentrations of either ≥ 20% (baseline to day 1) or ≥ 50% (baseline to day 4) but continuously high MR-proADM concentrations had a significantly increased mortality risk (HR (95% CI): 19.1 (8.0–45.9) and 43.1 (10.1–184.0)). Conclusions MR-proADM identifies disease severity and treatment response more accurately than established biomarkers and scores, adding additional information to facilitate rapid clinical decision-making and improve personalised sepsis treatment. Electronic supplementary material The online version of this article (10.1186/s13054-018-2001-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gunnar Elke
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3 Haus 12, 24105, Kiel, Germany.
| | - Frank Bloos
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.,Center for Sepsis Control & Care (CSCC), Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | | | - Frank Martin Brunkhorst
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.,Center for Sepsis Control & Care (CSCC), Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Josef Briegel
- Department of Anaesthesiology, University Hospital Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Konrad Reinhart
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.,Center for Sepsis Control & Care (CSCC), Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Markus Loeffler
- Clinical Trial Centre Leipzig, University of Leipzig, Härtelstraße 16-18, 04107, Leipzig, Germany
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Axel Nierhaus
- Department of Intensive Care Medicine, University Hospital Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Ulrich Jaschinski
- Department of Anaesthesiology and Surgical Intensive Care Medicine, Hospital Augsburg, Stenglinstrasse 2, 86156, Augsburg, Germany
| | - Onnen Moerer
- Department of Anaesthesiology, University Hospital Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Germany
| | - Andreas Weyland
- University Department for Anesthesia, Intensive and Emergency Medicine and Pain Management, Hospital Oldenburg, Rahel-Straus-Str. 10, 26133, Oldenburg, Germany
| | - Patrick Meybohm
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
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22
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Bernal-Morell E, García-Villalba E, Vera MDC, Medina B, Martinez M, Callejo V, Valero S, Cinesi C, Piñera P, Alcaraz A, Marin I, Muñoz A, Cano A. Usefulness of midregional pro-adrenomedullin as a marker of organ damage and predictor of mortality in patients with sepsis. J Infect 2018; 76:249-257. [DOI: 10.1016/j.jinf.2017.12.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 12/03/2017] [Accepted: 12/06/2017] [Indexed: 12/30/2022]
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23
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Choi JJ, McCarthy MW. The prognostic value of mid-regional pro-adrenomedullin in the evaluation of acute dyspnea. Expert Rev Mol Diagn 2018; 18:147-153. [DOI: 10.1080/14737159.2018.1427069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Justin J. Choi
- Department of Medicine, Weill Cornell Medical College, New York, USA
| | - Matthew W. McCarthy
- Weill Cornell Medical College, Division of General Internal Medicine, New York-Presbyterian Hospital, New York, NY, USA
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24
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Shetty A, Macdonald SP, Keijzers G, Williams JM, Tang B, de Groot B, Thompson K, Fraser JF, Finfer S, Bellomo R, Iredell J. Review article: Sepsis in the emergency department - Part 2: Investigations and monitoring. Emerg Med Australas 2018; 30:4-12. [PMID: 29341498 DOI: 10.1111/1742-6723.12924] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 12/01/2017] [Indexed: 12/14/2022]
Abstract
Sepsis is characterised by organ dysfunction resulting from infection, with no reliable single objective test and current diagnosis based on clinical features and results of investigations. In the ED, investigations may be conducted to diagnose infection as the cause of the presenting illness, identify the source, distinguish sepsis from uncomplicated infection (i.e. without organ dysfunction) and/ or risk stratification. Appropriate sample collection for microbiological testing remains key for subsequent confirmation of diagnosis and rationalisation of antimicrobials. Routine laboratory investigations such as creatinine, bilirubin, platelet count and lactate are now critical elements in the diagnosis of sepsis and septic shock. With no biomarker sufficiently validated to rule out bacterial infection in the ED, there remains substantial interest in biomarkers representing various pathogenic pathways. New technologies for screening multiple genes and proteins are identifying unique network 'signatures' of clinical interest. Other future directions include rapid detection of bacterial DNA in blood, genes for antibiotic resistance and EMR-based computational biomarkers that collate multiple information sources. Reliable, cost-effective tests, validated in the ED to promptly and accurately identify sepsis, and to guide initial antibiotic choices, are important goals of current research efforts.
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Affiliation(s)
- Amith Shetty
- Emergency Department, Westmead Hospital, Sydney, New South Wales, Australia.,Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Stephen Pj Macdonald
- Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia.,Department of Emergency Medicine, Royal Perth Hospital, Perth, Western Australia, Australia.,Division of Emergency Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Gerben Keijzers
- School of Medicine, Bond University, Gold Coast, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Julian M Williams
- Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Benjamin Tang
- Immunology Department, Westmead Millennium Institute for Medical Research, Sydney, New South Wales, Australia.,Nepean Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Bas de Groot
- Department of Emergency Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - Kelly Thompson
- Critical Care and Trauma Division, George Institute for Global Health, Sydney, New South Wales, Australia
| | - John F Fraser
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia.,Intensive Care Unit, St Andrew's War Memorial Hospital, Brisbane, Queensland, Australia
| | - Simon Finfer
- Division of Critical Care, George Institute for Global Health, Sydney, New South Wales, Australia
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia.,School of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jonathan Iredell
- Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,Infectious Diseases, Westmead Hospital, Western Sydney Local Health District, Sydney, New South Wales, Australia.,Institute of Clinical Pathology and Medical Research, Pathology West, Sydney, New South Wales, Australia
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25
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Andaluz-Ojeda D, Nguyen HB, Meunier-Beillard N, Cicuéndez R, Quenot JP, Calvo D, Dargent A, Zarca E, Andrés C, Nogales L, Eiros JM, Tamayo E, Gandía F, Bermejo-Martín JF, Charles PE. Superior accuracy of mid-regional proadrenomedullin for mortality prediction in sepsis with varying levels of illness severity. Ann Intensive Care 2017; 7:15. [PMID: 28185230 PMCID: PMC5307393 DOI: 10.1186/s13613-017-0238-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 01/27/2017] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The use of novel sepsis biomarkers has increased in recent years. However, their prognostic value with respect to illness severity has not been explored. In this work, we examined the ability of mid-regional proadrenomedullin (MR-proADM) in predicting mortality in sepsis patients with different degrees of organ failure, compared to that of procalcitonin, C-reactive protein and lactate. METHODS This was a two-centre prospective observational cohort, enrolling severe sepsis or septic shock patients admitted to the ICU. Plasma biomarkers were measured during the first 12 h of admission. The association between biomarkers and 28-day mortality was assessed by Cox regression analysis and Kaplan-Meier curves. Patients were divided into three groups as evaluated by the Sequential Organ Failure Assessment (SOFA) score. The accuracy of the biomarkers for mortality was determined by area under the receiver operating characteristic curve (AUROC) analysis. RESULTS A total of 326 patients with severe sepsis (21.7%) or septic shock (79.3%) were enrolled with a 28-day mortality rate of 31.0%. Only MR-proADM and lactate were associated with mortality in the multivariate analysis: hazard ratio 8.5 versus 3.4 (p < 0.001). MR-proADM showed the best AUROC for mortality prediction at 28 days in the analysis over the entire cohort (AUROC [95% CI] 0.79 [0.74-0.84]) (p < 0.001). When patients were stratified by the degree of organ failure, MR-proADM was the only biomarker to predict mortality in all severity groups (SOFA ≤ 6, SOFA = 7-12, and SOFA ≥ 13), AUROC [95% CI] of 0.75 [0.61-0.88], 0.74 [0.66-0.83] and 0.73 [0.59-0.86], respectively (p < 0.05). All patients with MR-proADM concentrations ≤0.88 nmol/L survived up to 28 days. In patients with SOFA ≤ 6, the addition of MR-proADM to the SOFA score increased the ability of SOFA to identify non-survivors, AUROC [95% CI] 0.70 [0.58-0.82] and 0.77 [0.66-0.88], respectively (p < 0.05 for both). CONCLUSIONS The performance of prognostic biomarkers in sepsis is highly influenced by disease severity. MR-proADM accuracy to predict mortality is not affected by the degree of organ failure. Thus, it is a good candidate in the early identification of sepsis patients with moderate disease severity but at risk of mortality.
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Affiliation(s)
- David Andaluz-Ojeda
- Servicio de Medicina Intensiva, Hospital Clínico Universitario, Avda Ramón y Cajal 3, 47005 Valladolid, Spain
- Group for Biomedical Research in Sepsis (Bio∙Sepsis), Hospital Clínico Universitario, Avda Ramón y Cajal 3, 47005 Valladolid, Spain
| | - H. Bryant Nguyen
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Loma Linda University, Loma Linda, CA USA
| | - Nicolas Meunier-Beillard
- Service de Réanimation Médicale, Hôpital Bocage Central, C.H.U. DIJON, 14 rue Gaffarel, B.P. 77908-21079, Dijon Cedex, France
| | - Ramón Cicuéndez
- Servicio de Medicina Intensiva, Hospital Clínico Universitario, Avda Ramón y Cajal 3, 47005 Valladolid, Spain
- Group for Biomedical Research in Sepsis (Bio∙Sepsis), Hospital Clínico Universitario, Avda Ramón y Cajal 3, 47005 Valladolid, Spain
| | - Jean-Pierre Quenot
- Service de Réanimation Médicale, Hôpital Bocage Central, C.H.U. DIJON, 14 rue Gaffarel, B.P. 77908-21079, Dijon Cedex, France
| | - Dolores Calvo
- Servicio de Análisis Clínicos, Hospital Clínico Universitario, Avda Ramón y Cajal 3, 47005 Valladolid, Spain
| | - Auguste Dargent
- Service de Réanimation Médicale, Hôpital Bocage Central, C.H.U. DIJON, 14 rue Gaffarel, B.P. 77908-21079, Dijon Cedex, France
| | - Esther Zarca
- Servicio de Análisis Clínicos, Hospital Clínico Universitario, Avda Ramón y Cajal 3, 47005 Valladolid, Spain
| | - Cristina Andrés
- Servicio de Análisis Clínicos, Hospital Clínico Universitario, Avda Ramón y Cajal 3, 47005 Valladolid, Spain
| | - Leonor Nogales
- Servicio de Medicina Intensiva, Hospital Clínico Universitario, Avda Ramón y Cajal 3, 47005 Valladolid, Spain
- Group for Biomedical Research in Sepsis (Bio∙Sepsis), Hospital Clínico Universitario, Avda Ramón y Cajal 3, 47005 Valladolid, Spain
| | - Jose María Eiros
- Departmento de Microbiología, Facultad de Medicina, Universidad de Valladolid, Avda/Ramón y Cajal 7, 47005 Valladolid, Spain
| | - Eduardo Tamayo
- Group for Biomedical Research in Sepsis (Bio∙Sepsis), Hospital Clínico Universitario, Avda Ramón y Cajal 3, 47005 Valladolid, Spain
- Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario, Avda/Ramón y Cajal 3, 47005 Valladolid, Spain
| | - Francisco Gandía
- Servicio de Medicina Intensiva, Hospital Clínico Universitario, Avda Ramón y Cajal 3, 47005 Valladolid, Spain
- Group for Biomedical Research in Sepsis (Bio∙Sepsis), Hospital Clínico Universitario, Avda Ramón y Cajal 3, 47005 Valladolid, Spain
| | - Jesús F. Bermejo-Martín
- Group for Biomedical Research in Sepsis (Bio∙Sepsis), Hospital Clínico Universitario, Avda Ramón y Cajal 3, 47005 Valladolid, Spain
| | - Pierre Emmanuel Charles
- Service de Réanimation Médicale, Hôpital Bocage Central, C.H.U. DIJON, 14 rue Gaffarel, B.P. 77908-21079, Dijon Cedex, France
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26
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Legramante JM, Mastropasqua M, Susi B, Porzio O, Mazza M, Miranda Agrippino G, D′Agostini C, Brandi A, Giovagnoli G, Di Lecce VN, Bernardini S, Minieri M. Prognostic performance of MR-pro-adrenomedullin in patients with community acquired pneumonia in the Emergency Department compared to clinical severity scores PSI and CURB. PLoS One 2017; 12:e0187702. [PMID: 29161297 PMCID: PMC5697810 DOI: 10.1371/journal.pone.0187702] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Accepted: 10/24/2017] [Indexed: 02/07/2023] Open
Abstract
AIM (i) evaluate the performance of MR-pro-ADM in reflecting the outcome and risk for CAP patients in the emergency department, and (ii) compare the prognostic performance of MR-pro-ADM with that of clinical scores PSI and CURB65. METHODS Observational prospective, single-center study in patients with suspected community acquired pneumonia (CAP). Eighty one patients underwent full clinical and laboratory assessment as by protocol, and were followed up a 28 days. Primary endpoints measured were: death, death at 14 days, non-invasive mechanical ventilation (NIMV), endotracheal intubation (EI), ICU admission, overall hospital stay >10 days, emergency department stay >4 days. The discriminative performance of MR-pro-ADM and clinical scores was assessed by AUROC analysis. RESULTS The distribution for MR-pro-ADM followed an upward trend, increasing with the increase of both PSI (p<0.001) and CURB65 (p<0.001) classes. However, the difference between MRproADM values and score classes was significant only in the case of CURB65 classes 0 and 1 (p = 0.046), 2 (p = 0.013), and 3 (p = 0.011); and with PSI classes 5, 3 (p = 0.044), and 1 (p = 0.020). As to the differences among variables for the six end-points, MR-pro-ADM values in the two groups selected for each considered end-point differed in a statistically significant manner for all endpoints. Both PSI and CURB65 differed significantly for all end-points, except for stay in the ED longer than 4 days and the hospital stay longer than 10 days and endotracheal intubation (only PSI classes differed with statistical significance). ROC analyses evidenced that MR-pro-ADM values gave the greatest AUC for the prediction of death, endotracheal intubation, hospital stay >10 days and DE stay >4 days, compared to the PSI and CURB (though difference not statistically significant). For each endpoint measured, the best thresholds values for Mr-pro-ADM were: 1.6 (specificity 76.5%; sensitivity 77.8%) for death; 2.5 (specificity 88.9%; sensitivity 80.0%) for death at 14 days; 1.5 (specificity 77.0%; sensitivity 87.5%) for NIMV; 2.4 (specificity 88.7%; sensitivity 83.3%) for endotracheal intubation; 0.9 (specificity 53.5%; sensitivity 70.6%) for DE stay greater than 4 days; 1.9 (specificity 82.1%; sensitivity 55.3%) for hospital stay greater than 10 days. The AUC for the combination of MR-pro-ADM and PSI was 81.29% [63.41%-99.17%], but not in a statistically significant manner compared to the AUCs of the single predictors. Conversely, the AUC for the combination of MR-pro-ADM and CURB65 was 87.58% [75.54%-99.62%], which was significantly greater than the AUC of CURB65 (p = 0.047) or PSI (p = 0.017) alone. CONCLUSIONS The present study confirms that assessment of MR-pro-ADM levels in CAP patients in addition to CURB scores increases the prognostic accuracy of CURB alone and may help rule out discrepancies arising from flawed clinical severity classification. With particular reference to patients scoring in the upper classes of CURB and PSI, MR-pro-ADM values provided additional information towards a better risk stratification of those patients. In particular, our results pointed towards two MR-pro-ADM threshold values that appear to predict with a good degree of accuracy the patient's need for non-invasive mechanical ventilation, endotracheal intubation, or intensive care. This aspect, however, deserves further investigation.
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Affiliation(s)
- Jacopo Maria Legramante
- Emergency Department, Policlinico Tor Vergata, Roma, Italy
- Department of Medical Systems, Università di Tor Vergata, Roma, Italy
- * E-mail:
| | | | - Beniamino Susi
- Emergency Department, Policlinico Tor Vergata, Roma, Italy
| | - Ottavia Porzio
- Clinical Laboratory, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italy
- Department of Experimental Medicine and Surgery, Università di Tor Vergata, Roma, Italy
| | - Marta Mazza
- Medicina e Chirurgia d’Accettazione e d’Urgenza, Ospedale Maria Vittoria, Torino, Italy
| | | | | | | | | | | | - Sergio Bernardini
- Department of Experimental Medicine and Surgery, Università di Tor Vergata, Roma, Italy
- Laboratory of Clinical Biochemistry, Department of Laboratory Medicine, Policlinico Tor Vergata, Roma, Italy
| | - Marilena Minieri
- Department of Experimental Medicine and Surgery, Università di Tor Vergata, Roma, Italy
- Laboratory of Clinical Biochemistry, Department of Laboratory Medicine, Policlinico Tor Vergata, Roma, Italy
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van der Maas ME, Mantjes G, Steuten LMG. Procalcitonin Biomarker Algorithm Reduces Antibiotic Prescriptions, Duration of Therapy, and Costs in Chronic Obstructive Pulmonary Disease: A Comparison in the Netherlands, Germany, and the United Kingdom. OMICS-A JOURNAL OF INTEGRATIVE BIOLOGY 2017; 21:232-243. [PMID: 28388301 DOI: 10.1089/omi.2016.0186] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Antibiotics are often recommended as treatment for patients with chronic obstructive pulmonary disease (COPD) exacerbations. However, not all COPD exacerbations are caused by bacterial infections and there is consequently considerable misuse and overuse of antibiotics among patients with COPD. This poses a severe burden on healthcare resources such as increased risk of developing antibiotic resistance. The biomarker procalcitonin (PCT) displays specificity to distinguish bacterial inflammations from nonbacterial inflammations and may therefore help to rationalize antibiotic prescriptions. We report in this study, a three-country comparison of the health and economic consequences of a PCT biomarker-guided prescription and clinical decision-making strategy compared to current practice in hospitalized patients with COPD exacerbations. A decision tree was developed, comparing the expected costs and effects of the PCT algorithm to current practice in the Netherlands, Germany, and the United Kingdom. The time horizon of the model captured the length of hospital stay and a societal perspective was also adopted. The primary health outcome was the duration of antibiotic therapy. The incremental cost-effectiveness ratio was defined as the incremental costs per antibiotic day avoided. The incremental cost savings per day on antibiotic therapy avoided were (in Euros) €90 in the Netherlands, €125 in Germany, and €52 in the United Kingdom. Probabilistic sensitivity analyses showed that in the majority of simulations, the PCT biomarker strategy was superior to current practice (the Netherlands: 58%, Germany: 58%, and the United Kingdom: 57%). In conclusion, the PCT biomarker algorithm to optimize antibiotic prescriptions in COPD is likely to be cost-effective compared to current practice. Both the percentage of patients who start with antibiotic treatment as well as the duration of antibiotic therapy are reduced with the PCT decision algorithm, leading to a decrease in total costs per patient. Economic analysis based on real-life data is recommended for further research. Biomarker-driven prescription algorithms are important instruments for personalized medicine in COPD. This also attests to the emerging convergence of biomarker innovations and the broader field of Health Technology Assessment (HTA).
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Affiliation(s)
| | | | - Lotte M G Steuten
- 1 PANAXEA B.V., Amsterdam, The Netherlands .,2 Fred Hutchinson Cancer Research Center, Hutchinson Institute for Cancer Outcomes Research , Seattle, Washington
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Prat C, Lacoma A. Bacteria in the respiratory tract-how to treat? Or do not treat? Int J Infect Dis 2017; 51:113-122. [PMID: 27776777 DOI: 10.1016/j.ijid.2016.09.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 08/30/2016] [Accepted: 09/04/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Acute and chronic respiratory tract infections are a common cause of inappropriate antimicrobial prescription. Antimicrobial therapy leads to the development of resistance and the emergence of opportunistic pathogens that substitute the indigenous microbiota. METHODS This review explores the major challenges and lines of research to adequately establish the clinical role of bacteria and the indications for antimicrobial treatment, and reviews novel therapeutic approaches. RESULTS In patients with chronic pulmonary diseases and structural disturbances of the bronchial tree or the lung parenchyma, clinical and radiographic signs and symptoms are almost constantly present, including a basal inflammatory response. Bacterial adaptative changes and differential phenotypes are described, depending on the clinical role and niche occupied. The respiratory tract has areas that are potentially inaccessible to antimicrobials. Novel therapeutic approaches include new ways of administering antimicrobials that may allow intracellular delivery or delivery across biofilms, targeting the functions essential for infection, such as regulatory systems, or the virulence factors required to cause host damage and disease. Alternatives to antibiotics and antimicrobial adjuvants are under development. CONCLUSIONS Prudent treatment, novel targets, and improved drug delivery systems will contribute to reduce the emergence of antimicrobial resistance in lower respiratory tract infections.
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Affiliation(s)
- Cristina Prat
- Microbiology Department, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol, Universitat Autònoma de Barcelona, Ctra del Canyet s/n, 08916 Badalona, Barcelona, Spain; CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.
| | - Alicia Lacoma
- Microbiology Department, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol, Universitat Autònoma de Barcelona, Ctra del Canyet s/n, 08916 Badalona, Barcelona, Spain; CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
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Kim MW, Lim JY, Oh SH. Mortality prediction using serum biomarkers and various clinical risk scales in community-acquired pneumonia. Scandinavian Journal of Clinical and Laboratory Investigation 2017; 77:486-492. [DOI: 10.1080/00365513.2017.1344298] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Min Woo Kim
- Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jee Yong Lim
- Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sang Hoon Oh
- Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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Odermatt J, Meili M, Hersberger L, Bolliger R, Christ-Crain M, Briel M, Bucher HC, Mueller B, Schuetz P. Pro-Adrenomedullin predicts 10-year all-cause mortality in community-dwelling patients: a prospective cohort study. BMC Cardiovasc Disord 2017; 17:178. [PMID: 28676115 PMCID: PMC5496393 DOI: 10.1186/s12872-017-0605-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 06/22/2017] [Indexed: 01/20/2023] Open
Abstract
Background Several studies found mid-regional pro-adrenomedullin (ProADM), the prohormone of the cardiovascular protein adrenomedullin, to be strongly associated with short-term mortality, mostly in the inpatient setting. We evaluated associations of ProADM levels with 10-year mortality in community-dwelling primary care patients with respiratory tract infections. Methods This is a post-hoc analysis using clinical and biomarker data of 134 primary care patients with respiratory tract infections. ProADM was measured on admission and after 7 days in batch-analysis. 10-year follow-up data was collected by GP, patient and relative tracing through phone interviews. We calculated Cox regression models and area under the receiver operating characteristics curves to assess associations of ProADM with 10-year all-cause mortality. Results During the 10-year follow-up 6% of included patients died. Median baseline ProADM blood levels (nmol/l) were significantly higher in non-survivors compared to survivors (0.5, IQR 0.4–1.3; vs. 0.2, IQR 0.1–0.5; p = 0.02) and showed a significant association with 10-year all-cause mortality in an age-adjusted cox regression model (HR: 2.5, 95%-CI: 1.0–6.1, p = 0.04). ProADM levels on day 7 showed similar results. Conclusions This posthoc analysis found an association of elevated ProADM blood levels and 10-year all-cause mortality in a primary care cohort with respiratory tract infections. Due to the methodological limitations including incomplete data regarding follow-up information and biomarker measurement, this study warrants validation in future larger studies. Trial registration Current Controlled Trials, SRCTN73182671
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Affiliation(s)
- Jonas Odermatt
- Department of Endocrinology, Diabetology and Metabolism, Medical University Clinic, Kantonsspital Aarau and University of Basel, Switzerland, Tellstrasse, CH-5001, Aarau, Switzerland
| | - Marc Meili
- Department of Endocrinology, Diabetology and Metabolism, Medical University Clinic, Kantonsspital Aarau and University of Basel, Switzerland, Tellstrasse, CH-5001, Aarau, Switzerland
| | - Lara Hersberger
- Department of Endocrinology, Diabetology and Metabolism, Medical University Clinic, Kantonsspital Aarau and University of Basel, Switzerland, Tellstrasse, CH-5001, Aarau, Switzerland
| | - Rebekka Bolliger
- Department of Endocrinology, Diabetology and Metabolism, Medical University Clinic, Kantonsspital Aarau and University of Basel, Switzerland, Tellstrasse, CH-5001, Aarau, Switzerland
| | - Mirjam Christ-Crain
- Department of Endocrinology, Diabetology and Metabolism, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Matthias Briel
- Department of Clinical Research, Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Basel-Stadt, Switzerland.,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Heiner C Bucher
- Department of Clinical Research, Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Basel-Stadt, Switzerland
| | - Beat Mueller
- Department of Endocrinology, Diabetology and Metabolism, Medical University Clinic, Kantonsspital Aarau and University of Basel, Switzerland, Tellstrasse, CH-5001, Aarau, Switzerland
| | - Philipp Schuetz
- Department of Endocrinology, Diabetology and Metabolism, Medical University Clinic, Kantonsspital Aarau and University of Basel, Switzerland, Tellstrasse, CH-5001, Aarau, Switzerland.
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Usefulness and prognostic value of biomarkers in patients with community-acquired pneumonia in the emergency department. Med Clin (Barc) 2017; 148:501-510. [PMID: 28391994 DOI: 10.1016/j.medcli.2017.02.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 02/08/2017] [Accepted: 02/16/2017] [Indexed: 01/10/2023]
Abstract
Between all patients treated in the Emergency Department (ED), 1.35% are diagnosed with community-acquired pneumonia (CAP). CAP is the main cause of death due to infectious disease (10-14%) and the most frequent reason of sepsis-septic shock in the ED. In the last decade, the search for objective tools to help establishing an early diagnosis, bacterial aetiology, severity, suspicion of bacteremia and the prognosis of mortality has increased. Biomarkers have shown their usefulness in this matter. Procalcitonin (obtains the highest accuracy for CAP diagnosis, bacterial aetiology and the presence of bacteremia), lactate (biomarker of hypoxia and tissue hypoperfusion) and proadrenomedullin (which has the greatest accuracy to predict mortality which in combination with the prognostic severity scales obtains even better results). The aim of this review is to highlight recently published scientific evidence and to compare the utility and prognostic accuracy of the biomarkers in CAP patients treated in the ED.
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Curbelo J, Luquero Bueno S, Galván-Román JM, Ortega-Gómez M, Rajas O, Fernández-Jiménez G, Vega-Piris L, Rodríguez-Salvanes F, Arnalich B, Díaz A, Costa R, de la Fuente H, Lancho Á, Suárez C, Ancochea J, Aspa J. Inflammation biomarkers in blood as mortality predictors in community-acquired pneumonia admitted patients: Importance of comparison with neutrophil count percentage or neutrophil-lymphocyte ratio. PLoS One 2017; 12:e0173947. [PMID: 28301543 PMCID: PMC5354424 DOI: 10.1371/journal.pone.0173947] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 03/01/2017] [Indexed: 11/24/2022] Open
Abstract
Introduction The increase and persistence of inflammation in community-acquired pneumonia (CAP) patients can lead to higher mortality. Biomarkers capable of measuring this inadequate inflammatory response are likely candidates to be related with a bad outcome. We investigated the association between concentrations of several inflammatory markers and mortality of CAP patients. Material and methods This was a prospective study of hospitalised CAP patients in a Spanish university hospital. Blood tests upon admittance and in the early-stage evolution (72–120 hours) were carried out, where C-reactive protein, procalcitonin, proadrenomedullin, copeptin, white blood cell, Lymphocyte Count Percentage (LCP), Neutrophil Count Percentage (NCP) and Neutrophil/Lymphocyte Ratio (NLR) were measured. The outcome variable was mortality at 30 and 90 days. Statistical analysis included logistic regression, ROC analysis and area-under-curve test. Results 154 hospitalised CAP patients were included. Patients who died during follow-up had higher levels of procalcitonin, copeptin, proadrenomedullin, lower levels of LCP, and higher of NCP and NLR. Remarkably, multivariate analysis showed a relationship between NCP and mortality, regardless of age, severity of CAP and comorbidities. AUC analysis showed that NLR and NCP at admittance and during early-stage evolution achieved a good diagnostic power. ROC test for NCP and NLR were similar to those of the novel serum biomarkers analysed. Conclusions NLR and NCP, are promising candidate predictors of mortality for hospitalised CAP patients, and both are cheaper, easier to perform, and at least as reliable as the new serum biomarkers. Future implementation of new biomarkers would require comparison not only with classic inflammatory parameters like White Blood Cell count but also with NLR and NCP.
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Affiliation(s)
- Jose Curbelo
- Department of Internal Medicine, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa, Madrid, Spain
| | - Sergio Luquero Bueno
- Biobank, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa, Madrid, Spain
| | - José María Galván-Román
- Department of Immunology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa, Madrid, Spain
| | - Mara Ortega-Gómez
- Biobank, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa, Madrid, Spain
| | - Olga Rajas
- Department of Pneumology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa, Madrid, Spain
| | - Guillermo Fernández-Jiménez
- Clinical Information Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa, Madrid, Spain
| | - Lorena Vega-Piris
- Methodology Unit, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa, Madrid, Spain
| | | | - Belén Arnalich
- Department of Pneumology, Hospital del Henares, Madrid, Spain
| | - Ana Díaz
- Department of Clinical Analysis, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa, Madrid, Spain
| | - Ramón Costa
- Department of Internal Medicine, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa, Madrid, Spain
| | - Hortensia de la Fuente
- Department of Immunology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa, Madrid, Spain
| | - Ángel Lancho
- Department of Immunology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa, Madrid, Spain
| | - Carmen Suárez
- Department of Internal Medicine, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa, Madrid, Spain
| | - Julio Ancochea
- Department of Pneumology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa, Madrid, Spain
| | - Javier Aspa
- Department of Pneumology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria del Hospital Universitario de la Princesa, Madrid, Spain
- * E-mail:
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Abstract
Sepsis is a common condition managed in the emergency department. Current diagnosis relies on physiologic criteria and suspicion of a source of infection using history, physical examination, laboratory studies, and imaging studies. The infection triggers a host response with the aim to destroy the pathogen, and this response can be measured. A reliable biomarker for sepsis should assist with earlier diagnosis, improve risk stratification, or improve clinical decision making. Current biomarkers for sepsis include lactate, troponin, and procalcitonin. This article discusses the use of lactate, procalcitonin, troponin, and novel biomarkers for use in sepsis.
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Kutz A, Hausfater P, Amin D, Amin A, Canavaggio P, Sauvin G, Bernard M, Conca A, Haubitz S, Struja T, Huber A, Mueller B, Schuetz P. The TRIAGE-ProADM Score for an Early Risk Stratification of Medical Patients in the Emergency Department - Development Based on a Multi-National, Prospective, Observational Study. PLoS One 2016; 11:e0168076. [PMID: 28005916 PMCID: PMC5179054 DOI: 10.1371/journal.pone.0168076] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 11/27/2016] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION The inflammatory biomarker pro-adrenomedullin (ProADM) provides additional prognostic information for the risk stratification of general medical emergency department (ED) patients. The aim of this analysis was to develop a triage algorithm for improved prognostication and later use in an interventional trial. METHODS We used data from the multi-national, prospective, observational TRIAGE trial including consecutive medical ED patients from Switzerland, France and the United States. We investigated triage effects when adding ProADM at two established cut-offs to a five-level ED triage score with respect to adverse clinical outcome. RESULTS Mortality in the 6586 ED patients showed a step-wise, 25-fold increase from 0.6% to 4.5% and 15.4%, respectively, at the two ProADM cut-offs (≤0.75nmol/L, >0.75-1.5nmol/L, >1.5nmol/L, p ANOVA <0.0001). Risk stratification by combining ProADM within cut-off groups and the triage score resulted in the identification of 1662 patients (25.2% of the population) at a very low risk of mortality (0.3%, n = 5) and 425 patients (6.5% of the population) at very high risk of mortality (19.3%, n = 82). Risk estimation by using ProADM and the triage score from a logistic regression model allowed for a more accurate risk estimation in the whole population with a classification of 3255 patients (49.4% of the population) in the low risk group (0.3% mortality, n = 9) and 1673 (25.4% of the population) in the high-risk group (15.1% mortality, n = 252). CONCLUSIONS Within this large international multicenter study, a combined triage score based on ProADM and established triage scores allowed a more accurate mortality risk discrimination. The TRIAGE-ProADM score improved identification of both patients at the highest risk of mortality who may benefit from early therapeutic interventions (rule in), and low risk patients where deferred treatment without negatively affecting outcome may be possible (rule out).
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Affiliation(s)
- Alexander Kutz
- Division of General and Emergency Medicine; University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Pierre Hausfater
- Emergency Department, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
- Sorbonne Universités UPMC-Univ Paris06, UMRS INSERM 1166, IHUC ICAN, Paris, France
| | - Devendra Amin
- Morton Plant Hospital, Clearwater, FL, United States of America
| | - Adina Amin
- Morton Plant Hospital, Clearwater, FL, United States of America
| | - Pauline Canavaggio
- Emergency Department, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Gabrielle Sauvin
- Emergency Department, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Maguy Bernard
- Biochemistry Department, Hôpital Pitié-Salpêtrière and Univ-Paris Descartes, Paris, France
| | - Antoinette Conca
- Division of General and Emergency Medicine; University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Sebastian Haubitz
- Division of General and Emergency Medicine; University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Tristan Struja
- Division of General and Emergency Medicine; University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Andreas Huber
- Department of Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Beat Mueller
- Division of General and Emergency Medicine; University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Philipp Schuetz
- Division of General and Emergency Medicine; University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
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Braun N, Hoess C, Kutz A, Christ-Crain M, Thomann R, Henzen C, Zimmerli W, Mueller B, Schuetz P. Obesity paradox in patients with community-acquired pneumonia: Is inflammation the missing link? Nutrition 2016; 33:304-310. [PMID: 27742103 DOI: 10.1016/j.nut.2016.07.016] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 07/18/2016] [Accepted: 07/24/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Positive associations between body mass index (BMI) and clinical outcomes have been found and are called "the obesity survival paradox." However, whether obesity has protective effects or if this paradox is because of confounding remains unclear. Herein, we analyzed the effects of weight on long-term mortality in a large cohort of patients with community-acquired pneumonia (CAP) and investigated whether the differential effects of obesity on inflammation pathways accounted for mortality differences. METHODS For this secondary analysis, we followed prospectively for 6 y 763 CAP patients who were previously included in a multicenter trial (the ProHOSP Trial). To assess associations of BMI with mortality and with several inflammatory biomarker levels, we calculated three regression models adjusted for severity: the pneumonia severity index (PSI); fully adjusted for PSI, age, sex, metabolic factors, cardiovascular diseases, and other comorbidities; and fully adjusted including biomarker levels. RESULTS Within the 763 patients studied, all-cause 6-y mortality was significantly lower in obese patients (BMI >30 kg/m2) compared with normal-weight patients (BMI 18.5-25 kg/m2), with a severity-adjusted hazard ratio of 0.641 (95% confidence interval 0.462-0.889) and robust results in fully adjusted and fully adjusted plus biomarker models. No associations of increased BMI and C-reactive protein, procalcitonin, or white blood cell count were found, but BMI > 30 kg/m2 was associated with higher proadrenomedullin levels. CONCLUSIONS Over a 6-y long-term follow-up, we found obesity to be associated with lower all-cause mortality in CAP patients, confirming the obesity paradox in this population. However, differences in inflammatory pathways did not explain these findings.
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Affiliation(s)
- Nina Braun
- Internal Medicine, Kantonsspital Münsterlingen, Switzerland; University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Claus Hoess
- Internal Medicine, Kantonsspital Münsterlingen, Switzerland
| | - Alexander Kutz
- University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Mirjam Christ-Crain
- Department of Internal Medicine, Division of Endocrinology, Diabetes and Clinical Nutrition, Universitätsspital Basel, Basel, Switzerland
| | - Robert Thomann
- Department of Internal Medicine, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Christoph Henzen
- Department of Internal Medicine, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Beat Mueller
- University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Basel, Switzerland
| | - Philipp Schuetz
- University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland; Medical Faculty of the University of Basel, Basel, Switzerland.
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Liu D, Xie L, Zhao H, Liu X, Cao J. Prognostic value of mid-regional pro-adrenomedullin (MR-proADM) in patients with community-acquired pneumonia: a systematic review and meta-analysis. BMC Infect Dis 2016; 16:232. [PMID: 27230573 PMCID: PMC4881068 DOI: 10.1186/s12879-016-1566-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 05/16/2016] [Indexed: 01/31/2023] Open
Abstract
Background The early identification of patients at risk of dying from community-acquired pneumonia (CAP) is critical for their treatment and for defining hospital resource consumption. Mid-regional pro-adrenomedullin (MR-proADM) has been extensively investigated for its prognostic value in CAP. However, the results are conflicting. The purpose of the present meta-analysis was to explore the diagnostic accuracy of MR-proADM for predicting mortality in patients suffering from CAP, particularly emergency department (ED) patients. Method We systematically searched the PubMed, Embase, Web of Knowledge and Cochrane databases. Studies were included if a 2 × 2 contingency table could be constructed based on both the MR-proADM level and the complications or mortality of patients diagnosed with CAP. The prognostic accuracy of MR-proADM in CAP was assessed using the bivariate meta-analysis model. We used the Q-test and I2 index to evaluate heterogeneity. Results MR-proADM displayed moderate diagnostic accuracy for predicting complications in CAP, with an overall area under the SROC curve (AUC) of 0.74 (95 % CI: 0.70–0.78). Eight studies with a total of 4119 patients in the emergency department (ED) were included. An elevated MR-proADM level was associated with increased risk of death from CAP (RR 6.16, 95 % CI 4.71–8.06); the I2 value was 0.0 %, and a fixed-effects model was used to pool RR. The pooled sensitivity and specificity were 0.74 (95 % CI: 0.67–0.79) and 0.73 (95 % CI: 0.70–0.77), respectively. The positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were 2.8 (95 % CI, 2.3–3.3) and 0.36 (95 % CI, 0.29–0.45), respectively. In addition, the diagnostic odds ratio (DOR) was 8 (95 % CI, 5–11), and the overall area under the SROC curve was 0.76 (95 % CI, 0.72–0.80). Conclusions Our study has demonstrated that MR-proADM is predictive of increased complications and higher mortality rates in patients suffering from CAP. Future studies are warranted to determine the prognostic accuracy of MR-proADM in conjunction with severity scores or other biomarkers and to determine an optimal cut-off level. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1566-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dan Liu
- Department of Respiratory Medicine, Tianjin Medical University General Hospital, Tianjin, 300070, China
| | - Lixin Xie
- Department of Pulmonary & Critical Care Medicine, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Haiyan Zhao
- Department of Respiratory Medicine, Tianjin Medical University General Hospital, Tianjin, 300070, China
| | - Xueyao Liu
- Medical School, Nankai University, 94 Weijin Road, Tianjin, 300071, China.,Department of Pulmonary & Critical Care Medicine, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Jie Cao
- Department of Respiratory Medicine, Tianjin Medical University General Hospital, Tianjin, 300070, China.
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Viasus D, Del Rio-Pertuz G, Simonetti AF, Garcia-Vidal C, Acosta-Reyes J, Garavito A, Carratalà J. Biomarkers for predicting short-term mortality in community-acquired pneumonia: A systematic review and meta-analysis. J Infect 2016; 72:273-82. [PMID: 26777314 DOI: 10.1016/j.jinf.2016.01.002] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 01/07/2016] [Accepted: 01/08/2016] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The pneumonia severity index and CURB-65 are risk assessment tools widely used in community-acquired pneumonia (CAP). However, limitations in these prognostic scores have led to increasing interest in finding biomarkers that might provide additional information. To date, the role of these biomarkers has not been fully elucidated. METHODS We systematically searched the Medline, Web of Knowledge, Science Direct, and LILACS databases. We included studies that assessed the accuracy of biomarkers for the prediction of in-hospital or ≤30-day mortality, in hospitalized adults with CAP. Two independent investigators extracted patient and study characteristics, which were thereafter pooled using a random effects model. Relationships between sensitivity and specificity of biomarkers and prognostic scores were plotter using the area under the receiver operator characteristic curve (AUC). RESULTS We included 24 articles and 2 databases from 1069 reviewed abstracts, which provided 10,319 patients for analysis. Reported mortality rates varied from 2.4% to 34.6%. The highest AUC values for predicting mortality were associated with pro-adrenomedullin (0.80) and prohormone forms of atrial natriuretic peptide (0.79), followed by cortisol (0.78), procalcitonin (0.75), copeptin (0.71), and C-reactive protein (0.62). There were no statistically significant differences between the AUCs of the studied biomarkers, other than for copeptin and C-reactive protein, which performed comparatively poorly. When compared with the CAP-specific scores, the AUCs were not significantly different from those of most biomarkers. CONCLUSIONS The identified biomarkers are able to predict mortality with moderate to good accuracy in CAP. However, biomarkers have no clear advantage over CAP-specific scores for predicting mortality.
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Affiliation(s)
- Diego Viasus
- Division of Health Sciences, Faculty of Medicine, Universidad del Norte, and Hospital Universidad del Norte, Colombia.
| | - Gaspar Del Rio-Pertuz
- Division of Health Sciences, Faculty of Medicine, Universidad del Norte, and Hospital Universidad del Norte, Colombia
| | - Antonella F Simonetti
- Infectious Disease Department, Hospital Universitari de Bellvitge - IDIBELL, and Spanish Network for Research in Infectious Diseases (REIPI), Spain
| | - Carolina Garcia-Vidal
- Infectious Disease Department, Hospital Universitari de Bellvitge - IDIBELL, and Spanish Network for Research in Infectious Diseases (REIPI), Spain
| | - Jorge Acosta-Reyes
- Department of Public Health, Universidad del Norte, and Hospital Universidad del Norte, Colombia
| | - Argenis Garavito
- Clínica Medilaser S.A. - Sucursal Florencia, Fundación Universitaria Navarra, Colombia
| | - Jordi Carratalà
- Infectious Disease Department, Hospital Universitari de Bellvitge - IDIBELL, and Spanish Network for Research in Infectious Diseases (REIPI), Spain; Clinical Science Department, Faculty of Medicine, University of Barcelona, Spain
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MR-proANP, MR-proADM, and PCT in Patients Presenting with Acute Dyspnea in a Medical Emergency Unit. Lung 2016; 194:185-91. [DOI: 10.1007/s00408-015-9837-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 12/26/2015] [Indexed: 01/01/2023]
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Nickler M, Schaffner D, Christ-Crain M, Ottiger M, Thomann R, Hoess C, Henzen C, Mueller B, Schuetz P. Prospective evaluation of biomarkers for prediction of quality of life in community-acquired pneumonia. ACTA ACUST UNITED AC 2016; 54:1831-1846. [DOI: 10.1515/cclm-2016-0001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Accepted: 03/10/2016] [Indexed: 01/22/2023]
Abstract
AbstractBackground:Most clinical research investigated prognostic biomarkers for their ability to predict cardiovascular events or mortality. It is unknown whether biomarkers allow prediction of quality of life (QoL) after survival of the acute event. Herein, we investigated the prognostic potential of well-established inflammatory/cardiovascular blood biomarkers including white blood cells (WBC), C-reactive protein (CRP), procalcitonin (PCT), pro-adrenomedullin (proADM) and pro-atrial natriuretic peptide (proANP) in regard to a decline in QoL in a well-defined cohort of patients with community-acquired pneumonia (CAP).Methods:Within this secondary analysis including 753 patients with a final inpatient diagnosis of CAP from a multicenter trial, we investigated associations between admission biomarker levels and decline in QoL assessed by the EQ-5D health questionnaire from admission to day 30 and after 6 years.Results:Admission proADM and proANP levels significantly predicted decline of the weighted EQ-5D index after 30 days (n=753) with adjusted odds ratios (ORs) of 2.0 ([95% CI 1.1–3.8]; p=0.027) and 3.7 ([95% CI 2.2–6.0]; p<0.001). Results for 6-year outcomes (n=349) were similar with ORs of 3.3 ([95% CI 1.3–8.3]; p=0.012) and 6.2 ([95% CI 2.7–14.2]; p<0.001). The markers were associated with most of the different QoL dimensions including mobility, self-care, and usual activities, but not pain/discomfort and to a lesser degree anxiety/depression and the visual analogue scale (VAS). Initial WBC, PCT and CRP values did not well predict QoL at any time point.Conclusions:ProADM and proANP accurately predict short- and long-term decline in QoL across most dimensions in CAP patients. It will be interesting to reveal underlying physiopathology in future studies.
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Nickel CH, Messmer AS, Ghanim L, Ilsemann-Karakoumis J, Giersdorf S, Hertel S, Ernst S, Geigy N, Bingisser R. Adrenomedullin for Risk Stratification of Emergency Patients With Nonspecific Complaints: An Interventional Multicenter Pilot Study. Medicine (Baltimore) 2016; 95:e2395. [PMID: 26735540 PMCID: PMC4706260 DOI: 10.1097/md.0000000000002395] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Patients with nonspecific complaints (NSC) presenting to the emergency department (ED) are at risk of life-threatening conditions. New stress biomarkers such as the midregional portion of adrenomedullin (MR-proADM) promise to support decision-making. This study tested the following hypotheses: biomarker-assisted disposition of patients with NSC will not increase mortality. Second, discharge from the ED will increase if clinical risk assessment is combined with low MR-proADM levels. Third, inappropriate disposition to a lower level of care will decrease, if clinical assessment is combined with high MR-proADM levels, and fourth that this algorithm is feasible in the ED setting. Prospective, multicenter, randomized, controlled interventional feasibility study with a 30-day follow-up, including patients with NSC. Patients were randomly assigned to either the standard group (decision-making solely based on clinical assessment) or the Novum group (biomarker-assisted). Regarding disposition, patients were assigned to 1 of 3 risk classes: high-risk (admission to hospital), intermediate risk (community geriatric hospital), and low-risk patients (discharge). In the Novum group, in addition to clinical risk assessment, the information of the MR-proADM level was used. Unless there were overruling criteria, patients were transferred or discharged according to the risk assessment. Primary endpoint was 30-day mortality. Secondary endpoints were comparisons of patient disposition and related mortality rates, ED, and hospital length of stay and readmission. The final study cohort consisted of 398 patients (210 in the Standard group and 188 in the Novum group). Overruling, that is, disposition not according to the result of the proposed algorithm occurred in 51 cases. Baseline characteristics between Standard and Novum groups were similar. The mortality rate in the Novum group was 4.3%, as compared to the Standard group mortality of 6.2%, which was not significantly different (intention-to treat analysis). This was confirmed by the perprotocol analysis as well as by sensitivity analysis. For the secondary endpoints, no significant differences were detected. Biomarker-assisted disposition is safe in patients with NSC. Discharge rates did not increase. Feasibility could only partly be shown due to an unexpectedly high overruling rate. Inappropriate disposition to lower levels of care did not change. ClinicalTrials. gov Identifier: NCT00920491.
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Affiliation(s)
- Christian Hans Nickel
- From the Emergency Department, University Hospital, Basel (CHN, ASM, LG, JI-K, RB); Emergency Department, Kantonsspital Baselland, Liestal, Switzerland (NG); Research Department, Thermo Scientific Biomarkers, Hennigsdorf, Germany (SG, SH); and Emergency Department, Kantonsspital Olten, Olten, Switzerland (SE)
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Csordas A, Nietlispach F, Schuetz P, Huber A, Müller B, Maisano F, Taramasso M, Moarof I, Obeid S, Stähli BE, Cahenzly M, Binder RK, Liebetrau C, Möllmann H, Kim WK, Hamm C, Lüscher TF. Midregional Proadrenomedullin Improves Risk Stratification beyond Surgical Risk Scores in Patients Undergoing Transcatheter Aortic Valve Replacement. PLoS One 2015; 10:e0143761. [PMID: 26630012 PMCID: PMC4667909 DOI: 10.1371/journal.pone.0143761] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 11/09/2015] [Indexed: 11/18/2022] Open
Abstract
Background Conventional surgical risk scores lack accuracy in risk stratification of patients undergoing transcatheter aortic valve replacement (TAVR). Elevated levels of midregional proadrenomedullin (MR-proADM) levels are associated with adverse outcome not only in patients with manifest chronic disease states, but also in the general population. Objectives We investigated the predictive value of MR-proADM for mortality in an unselected contemporary TAVR population. Methods We prospectively included 153 patients suffering from severe aortic stenosis who underwent TAVR from September 2013 to August 2014. This population was compared to an external validation cohort of 205 patients with severe aortic stenosis undergoing TAVR. The primary endpoint was all cause mortality. Results During a median follow-up of 258 days, 17 out of 153 patients who underwent TAVR died (11%). Patients with MR-proADM levels above the 75th percentile (≥ 1.3 nmol/l) had higher mortality (31% vs. 4%, HR 8.9, 95% CI 3.0–26.0, P < 0.01), whereas patients with EuroSCORE II scores above the 75th percentile (> 6.8) only showed a trend towards higher mortality (18% vs. 9%, HR 2.1, 95% CI 0.8–5.6, P = 0.13). The Harrell’s C-statistic was 0.58 (95% CI 0.45–0.82) for the EuroSCORE II, and consideration of baseline MR-proADM levels significantly improved discrimination (AUC = 0.84, 95% CI 0.71–0.92, P = 0.01). In bivariate analysis adjusted for EuroSCORE II, MR-proADM levels ≥1.3 nmol/l persisted as an independent predictor of mortality (HR 9.9, 95% CI (3.1–31.3), P <0.01) and improved the model’s net reclassification index (0.89, 95% CI (0.28–1.59). These results were confirmed in the independent validation cohort. Conclusions Our study identified MR-proADM as a novel predictor of mortality in patients undergoing TAVR. In the future, MR-proADM should be added to the commonly used EuroSCORE II for better risk stratification of patients suffering from severe aortic stenosis.
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Affiliation(s)
- Adam Csordas
- Department of Cardiology, University Heart Center Zürich, Zürich, Switzerland
| | - Fabian Nietlispach
- Department of Cardiology, University Heart Center Zürich, Zürich, Switzerland
- * E-mail:
| | - Philipp Schuetz
- Department of Internal Medicine and Cardiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Andreas Huber
- Department of Internal Medicine and Cardiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Beat Müller
- Department of Internal Medicine and Cardiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Francesco Maisano
- Department of Cardiovascular Surgery, University Heart Center Zürich, Zürich, Switzerland
| | - Maurizio Taramasso
- Department of Cardiovascular Surgery, University Heart Center Zürich, Zürich, Switzerland
| | - Igal Moarof
- Department of Internal Medicine and Cardiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Slayman Obeid
- Department of Cardiology, University Heart Center Zürich, Zürich, Switzerland
| | - Barbara E. Stähli
- Department of Cardiology, University Heart Center Zürich, Zürich, Switzerland
| | - Martin Cahenzly
- Department of Cardiology, University Heart Center Zürich, Zürich, Switzerland
| | - Ronald K. Binder
- Department of Cardiology, University Heart Center Zürich, Zürich, Switzerland
| | | | - Helge Möllmann
- Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Won-Keun Kim
- Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Christian Hamm
- Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Thomas F. Lüscher
- Department of Cardiology, University Heart Center Zürich, Zürich, Switzerland
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Schuetz P, Marlowe RJ, Mueller B. The prognostic blood biomarker proadrenomedullin for outcome prediction in patients with chronic obstructive pulmonary disease (COPD): a qualitative clinical review. Clin Chem Lab Med 2015; 53:521-39. [PMID: 25252756 DOI: 10.1515/cclm-2014-0748] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 08/24/2014] [Indexed: 01/29/2023]
Abstract
Plasma proadrenomedullin (ProADM) is a blood biomarker that may aid in multidimensional risk assessment of patients with chronic obstructive pulmonary disease (COPD). Co-secreted 1:1 with adrenomedullin (ADM), ProADM is a less biologically active, more chemically stable surrogate for this pluripotent regulatory peptide, which due to biological and ex vivo physical characteristics is difficult to reliably directly quantify. Upregulated by hypoxia, inflammatory cytokines, bacterial products, and shear stress and expressed widely in pulmonary cells and ubiquitously throughout the body, ADM exerts or mediates vasodilatory, natriuretic, diuretic, antioxidative, anti-inflammatory, antimicrobial, and metabolic effects. Observational data from four separate studies totaling 1366 patients suggest that as a single factor, ProADM is a significant independent, and accurate, long-term all-cause mortality predictor in COPD. This body of work also suggests that combined with different groups of demographic/clinical variables, ProADM provides significant incremental long-term mortality prediction power relative to the groups of variables alone. Additionally, the literature contains indications that ProADM may be a global cardiopulmonary stress marker, potentially supplying prognostic information when cardiopulmonary exercise testing results such as 6-min walk distance are unavailable due to time or other resource constraints or to a patient's advanced disease. Prospective, randomized, controlled interventional studies are needed to demonstrate whether ProADM use in risk-based guidance of site-of-care, monitoring, and treatment decisions improves clinical, quality-of-life, or pharmacoeconomic outcomes in patients with COPD.
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Zhydkov A, Christ-Crain M, Thomann R, Hoess C, Henzen C, Werner Z, Mueller B, Schuetz P. Utility of procalcitonin, C-reactive protein and white blood cells alone and in combination for the prediction of clinical outcomes in community-acquired pneumonia. Clin Chem Lab Med 2015; 53:559-66. [PMID: 25014522 DOI: 10.1515/cclm-2014-0456] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 06/13/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND The added value of biomarkers, such as procalcitonin (PCT), C-reactive protein (CRP), and white blood cells (WBC), as adjuncts to clinical risk scores for predicting the outcome of patients with community-acquired pneumonia (CAP) is in question. We investigated the prognostic accuracy of initial and follow-up levels of inflammatory biomarkers in predicting death and adverse clinical outcomes in a large and well-defined cohort of CAP patients. METHODS We measured PCT, CRP and WBC on days 1, 3, 5, and 7 and followed the patients over 30 days. We applied multivariate regression models and area under the curve (AUC) to investigate associations between these biomarkers, the clinical risk score CURB-65, and clinical outcomes [i.e., death and intensive care unit (ICU) admission]. RESULTS Of 925 patients with CAP, 50 patients died and 118 patients had an adverse clinical outcome. None of the initial biomarker levels significantly improved the CURB-65 score for mortality prediction. Follow-up biomarker levels showed significant independent association with mortality at days 3, 5, and 7 and with improvements in AUC. Initial PCT and CRP levels were independent prognostic predictors of adverse clinical outcome, and levels of all biomarkers during the course of disease provided additional prognostic information. CONCLUSIONS This study provides robust insights into the added prognostic value of inflammatory markers in CAP. Procalcitonin, CRP, and to a lesser degree WBC provided some prognostic information on CAP outcomes, particularly when considering their kinetics at days 5 and 7 and when looking at adverse clinical outcomes instead of mortality alone.
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Schuetz P, Hausfater P, Amin D, Amin A, Haubitz S, Faessler L, Kutz A, Conca A, Reutlinger B, Canavaggio P, Sauvin G, Bernard M, Huber A, Mueller B. Biomarkers from distinct biological pathways improve early risk stratification in medical emergency patients: the multinational, prospective, observational TRIAGE study. Crit Care 2015; 19:377. [PMID: 26511878 PMCID: PMC4625457 DOI: 10.1186/s13054-015-1098-z] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 10/10/2015] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Early risk stratification in the emergency department (ED) is vital to reduce time to effective treatment in high-risk patients and to improve patient flow. Yet, there is a lack of investigations evaluating the incremental usefulness of multiple biomarkers measured upon admission from distinct biological pathways for predicting fatal outcome and high initial treatment urgency in unselected ED patients in a multicenter and multinational setting. METHOD We included consecutive, adult, medical patients seeking ED care into this observational, cohort study in Switzerland, France and the USA. We recorded initial clinical parameters and batch-measured prognostic biomarkers of inflammation (pro-adrenomedullin [ProADM]), stress (copeptin) and infection (procalcitonin). RESULTS During a 30-day follow-up, 331 of 7132 (4.6 %) participants reached the primary endpoint of death within 30 days. In logistic regression models adjusted for conventional risk factors available at ED admission, all three biomarkers strongly predicted the risk of death (AUC 0.83, 0.78 and 0.75), ICU admission (AUC 0.67, 0.69 and 0.62) and high initial triage priority (0.67, 0.66 and 0.58). For the prediction of death, ProADM significantly improved regression models including (a) clinical information available at ED admission (AUC increase from 0.79 to 0.84), (b) full clinical information at ED discharge (AUC increase from 0.85 to 0.88), and (c) triage information (AUC increase from 0.67 to 0.83) (p <0.01 for each comparison). Similarly, ProADM also improved clinical models for prediction of ICU admission and high initial treatment urgency. Results were robust in regard to predefined patient subgroups by center, main diagnosis, presenting symptoms, age and gender. CONCLUSIONS Combination of clinical information with results of blood biomarkers measured upon ED admission allows early and more adequate risk stratification in individual unselected medical ED patients. A randomized trial is needed to answer the question whether biomarker-guided initial patient triage reduces time to initial treatment of high-risk patients in the ED and thereby improves patient flow and clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT01768494 . Registered January 9, 2013.
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Affiliation(s)
- Philipp Schuetz
- Division of General and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Tellstrasse, 5001, Aarau, Switzerland.
- Medical Faculty of the University of Basel, Basel, Switzerland.
| | - Pierre Hausfater
- Emergency Department, Groupe Hospitalier Pitié-Salpêtrière Assistance Publique-Hôpitaux de Paris (APHP), Paris, France.
| | - Devendra Amin
- Department of critical care, Morton Plant Hospital, 300 Pinellas Street, Clearwater, FL, 33756, USA.
| | - Adina Amin
- Department of critical care, Morton Plant Hospital, 300 Pinellas Street, Clearwater, FL, 33756, USA.
| | - Sebastian Haubitz
- Division of General and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Tellstrasse, 5001, Aarau, Switzerland.
| | - Lukas Faessler
- Division of General and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Tellstrasse, 5001, Aarau, Switzerland.
| | - Alexander Kutz
- Division of General and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Tellstrasse, 5001, Aarau, Switzerland.
| | - Antoinette Conca
- Department of Clinical Nursing Science, Kantonsspital Aarau, Tellstrasse, 5001, Aarau, Switzerland.
| | - Barbara Reutlinger
- Department of Clinical Nursing Science, Kantonsspital Aarau, Tellstrasse, 5001, Aarau, Switzerland.
| | - Pauline Canavaggio
- Emergency Department, Groupe Hospitalier Pitié-Salpêtrière Assistance Publique-Hôpitaux de Paris (APHP), Paris, France.
| | - Gabrielle Sauvin
- Emergency Department, Groupe Hospitalier Pitié-Salpêtrière Assistance Publique-Hôpitaux de Paris (APHP), Paris, France.
| | - Maguy Bernard
- Biochemistry Department, Hôpital Pitié-Salpêtrière and Univ-Paris Descartes, Paris, France.
| | - Andreas Huber
- Department of Laboratory Medicine, Kantonsspital Aarau, Tellstrasse, 5001, Aarau, Switzerland.
| | - Beat Mueller
- Division of General and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Tellstrasse, 5001, Aarau, Switzerland.
- Medical Faculty of the University of Basel, Basel, Switzerland.
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Abstract
Community-acquired pneumonia is still a significant cause of morbidity and mortality and is often misdiagnosed and inappropriately treated. Although it can be caused by a wide variety of micro-organisms, the pneumococcus, atypicals, such as Mycoplasma pneumoniae and Chlamydophila pneumoniae,Staphylococcus aureus and certain Gram-negative rods are the usual pathogens encountered. The site-of-care decision is critical in determining the site and type of care as well as the extent of diagnostic workup. Antimicrobial therapy should be started as soon as possible particularly in those requiring admission to hospital, but typically the physician does not know with any degree of certainty the identity of the etiologic pathogen. A number of national guidelines have been published to help the physician with this choice. The initial drug(s) can be modified if necessary if the pathogen and its antimicrobial susceptibility pattern becomes known. Adjunctive therapy such as pressors and fluid replacement are of value and macrolides appear to help as well, likely secondary to their immunomodulatory effects. Recent data also suggest a role for steroids.
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Affiliation(s)
- Lionel A Mandell
- Department of Medicine, Division of Infectious Diseases, McMaster University , Hamilton, Ontario , Canada
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Kolditz M, Seyfarth HJ, Wilkens H, Ewert R, Bollmann T, Dinter C, Hertel S, Klose H, Opitz C, Grünig E, Höffken G, Halank M. MR-proADM Predicts Exercise Capacity and Survival Superior to Other Biomarkers in PH. Lung 2015; 193:901-10. [PMID: 26363916 DOI: 10.1007/s00408-015-9802-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 09/07/2015] [Indexed: 01/21/2023]
Abstract
PURPOSE Besides the established biomarker NT-proBNP, the new cardiovascular biomarkers MR-proANP, MR-proADM, Copeptin, and CT-proET-1 are promising to evaluate hemodynamics, exercise parameters, and prognosis in patients with pulmonary hypertension (PH). METHODS 125 consecutive patients with pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH) were prospectively enrolled at five German PH centers. Blood samples were taken during right heart catheterization. The primary study endpoint was the correlation between biomarkers and hemodynamic and exercise parameters. As secondary endpoint, prediction of 1-year mortality was evaluated. RESULTS MR-proADM showed the strongest correlations with 6MWD and VO2peak, whereas NT-proBNP showed the strongest correlations with PVR, PAPm, and CI. In multivariate analysis, only MR-proADM was independently associated with exercise variables, whereas only NT-proBNP independently predicted hemodynamic parameters. All biomarkers were associated with 1-year survival, with MR-proADM showing the highest C index of 0.78. In multivariate analysis, MR-proADM predicted survival independent of age, 6-MWD, CI, RAP, and NT-proBNP. The cut-off of 1.08 nmol/l provided a sensitivity of 83 % and specificity of 66 %. CONCLUSIONS Different biomarkers reflect distinctive disease aspects in PH. NT-proBNP best predicts hemodynamic impairment while MR-proADM strongly correlates with exercise capacity. Additionally, MR-proADM represents a promising new marker to evaluate prognosis in patients with PAH and CTEPH. Multi-marker strategies should further be evaluated.
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Affiliation(s)
- Martin Kolditz
- Division of Pulmonology, Medical Department I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
| | | | - Heinrike Wilkens
- Department of Internal Medicine V, Saarland University Medical Center, Homburg, Saarland, Germany
| | - Ralf Ewert
- Department of Internal Medicine B, Ernst-Moritz-Arndt Universität Greifswald, Greifswald, Germany
| | - Tom Bollmann
- Department of Internal Medicine B, Ernst-Moritz-Arndt Universität Greifswald, Greifswald, Germany
| | | | - Sabine Hertel
- BRAHMS GmbH (Thermo Fisher Scientific), Hennigsdorf, Germany
| | - Hans Klose
- Department of Pneumology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Opitz
- Department of Internal Medicine/Cardiology, DRK Kliniken Berlin Köpenick, Berlin, Germany
| | - Ekkehard Grünig
- Center for Pulmonary Hypertension at Thoraxclinic Heidelberg, Heidelberg, Germany
| | - Gert Höffken
- Division of Pulmonology, Medical Department I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Michael Halank
- Division of Pulmonology, Medical Department I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
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Bello S, Fandos S, Lasierra A, Mincholé E, Panadero C, Simon A, Gavin O, De Pablo F, Menendez R, Torres A. Red blood cell distribution width [RDW] and long-term mortality after community-acquired pneumonia. A comparison with proadrenomedullin. Respir Med 2015. [DOI: 10.1016/j.rmed.2015.07.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Alan M, Grolimund E, Kutz A, Christ-Crain M, Thomann R, Falconnier C, Hoess C, Henzen C, Zimmerli W, Mueller B, Schuetz P. Clinical risk scores and blood biomarkers as predictors of long-term outcome in patients with community-acquired pneumonia: a 6-year prospective follow-up study. J Intern Med 2015; 278:174-84. [PMID: 25529395 DOI: 10.1111/joim.12341] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Prediction of long-term outcomes in patients with community-acquired pneumonia (CAP) is incompletely understood. We investigated the value of clinical risk scores [pneumonia severity index (PSI) and CURB-65] (Confusion, Urea, Respiratory rate, Blood Pressure, Age >65 years) and blood biomarkers of different physiopathological pathways in predicting long-term survival in a well-characterized cohort of patients with CAP enrolled in an antibiotic stewardship trial. DESIGN, SETTING AND SUBJECTS Patients admitted with CAP to six medical centres in Switzerland were prospectively followed for 6 years. Cox regression models and area under the receiver operating characteristics curve (AUC) were used to investigate associations between initial risk assessment and all-cause mortality. MAIN OUTCOME MEASURE All-cause mortality during a 6-year follow-up period. RESULTS Six-year mortality in the present cohort (median age 73 years) was 45.1% [95% confidence interval (CI) 41.8-48.3%]. Initial PSI and CURB-65 scores both had excellent long-term prognostic accuracy, with a stepwise increase in mortality per risk class. The hazard ratios (95% CI) of the highest PSI and CURB-65 classes (reference: lowest class) were 38.0 (14.0-103.0) and 7.8 (2.2-14.5), respectively, after 6 years. The addition of inflammatory (pro-adrenomedullin) and cardiac (pro-atrial natriuretic peptide) blood biomarkers measured upon hospital admission further improved the prognostic capabilities of the PSI (AUC increase from 0.79 to 0.83; P < 0.0001) and the CURB-65 score (AUC increase from 0.73 to 0.80; P < 0.001). CONCLUSION Risk assessment using clinical scores allowed accurate long-term prognostication, which was further improved by the addition of two inflammatory (pro-adrenomedullin) and cardiac (pro-atrial natriuretic peptide) blood biomarkers. These data provide a rationale for a more risk-adapted, 'personalized' strategy for long-term management of patients with CAP.
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Affiliation(s)
- M Alan
- University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - E Grolimund
- University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - A Kutz
- University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - M Christ-Crain
- Department of Internal Medicine, Division of Endocrinology, Diabetes and Clinical Nutrition, University Hospital Basel, Basel, Switzerland
| | - R Thomann
- Department of Internal Medicine, Bürgerspital Solothurn, Solothurn, Switzerland
| | - C Falconnier
- Basel University Medical Clinic Liestal, Liestal, Switzerland
| | - C Hoess
- Department of Internal Medicine, Kantonsspital Münsterlingen, Münsterlingen, Switzerland
| | - C Henzen
- Department of Internal Medicine, Kantonsspital Lucerne, Lucerne, Switzerland
| | - W Zimmerli
- Basel University Medical Clinic Liestal, Liestal, Switzerland
| | - B Mueller
- University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - P Schuetz
- University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
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Cavallazzi R, El-Kersh K, Abu-Atherah E, Singh S, Loke YK, Wiemken T, Ramirez J. Midregional proadrenomedullin for prognosis in community-acquired pneumonia: a systematic review. Respir Med 2015; 108:1569-80. [PMID: 25448309 DOI: 10.1016/j.rmed.2014.09.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 09/27/2014] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The initial prognostic assessment of patients with community-acquired pneumonia( CAP) has important clinical implications. We hypothesized that midregional proadrenomedullin(MR-proADM) is a valuable test for the prediction of outcomes in patients with CAP.Methods: We performed a systemic review of the literature and a meta-analysis to evaluate the prognostic value of MR-proADM for short and long-term mortality in patients with CAP.Results: Twelve studies were included in the systematic review. Elevated MR-proADM was associated with an increase in short-term mortality (OR Z 6.8; 95% CI: 4.65-10.13; P value < 0.001) and complications (OR = 5.0; 95% CI: 3.86-6.49; P value < 0.001). The pooled analysis of 4 studies showed an improvement in the discriminant ability by 8% (95% CI: 2%e14%)when MR-proADM was added to CURB-65/CRB-65. Studies that reported long-term prognosis indicated an increased risk of death in patients with elevated MR-proADM.Conclusion: Elevated level of MR-proADM is significantly associated with both short-term mortality and complications in patients with CAP. Studies also indicate that MR-proADM has prognostic value for prediction of long-term mortality in these patients. The addition of MR-proADM improves the discriminant ability of CURB-65/CRB-65.
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Affiliation(s)
- Rodrigo Cavallazzi
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Disorders Medicine, University of Louisville, Louisville, KY, USA.
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Jordan I, Corniero P, Balaguer M, Ortiz J, Vila D, Velasco J, Cambra FJ, Esteban E. Adrenomedullin is a useful biomarker for the prognosis of critically ill septic children. Biomark Med 2015; 8:1065-72. [PMID: 25402577 DOI: 10.2217/bmm.14.77] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM To measure midregional pro-adrenomedullin (MR-pro-ADM) in critically ill septic patients to determine its prognostic usefulness as compared with other used biomarkers in pediatric intensive care units, C-reactive protein (CRP) and procalcitonin (PCT). MATERIALS & METHODS Prospective observational study conducted on 95 patients. RESULTS Mean levels of MR-pro-ADM were significantly higher when patients needed mechanical ventilation (3.2 ± 4.3 vs 1.6 ± 2.4) and inotropes (4.4 ± 5.2 vs 1.3 ± 1.2). Receiver operating characteristic curves of mortality were higher for MR-pro-ADM (cut-off value of 2.2). This marker showed higher positive predictive prognostic value than PCT and CRP (31 vs 21.6% and 15.8%, respectively). CONCLUSION MR-pro-ADM levels are good indicators of disease severity and show better reliability than PCT and CRP for predicting in-hospital mortality.
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Affiliation(s)
- Iolanda Jordan
- Pediatric Intensive Care Unit Service, Hospital de Sant Joan de Déu, Barcelona, Spain
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