ABSTRACT
BACKGROUND: We sought to evaluate the usefulness of biomarkers-procalcitonin (PCT), C-reactive protein (CRP) and proadrenomedullin (pro-ADM)-combined with prognostic scales (PSI, CURB-65 and SCAP score) for identifying adverse outcomes in patients with community-acquired pneumonia (CAP) attending at an Emergency Department (ED). METHODS: Prospective observational study in a teaching hospital among patients with CAP. In addition to collecting data for the prognostic scales, samples were taken at the ED for assessing PCT, CRP and pro-ADM levels. We compared the prognostic accuracy of these biomarkers with severity scores to predict pneumonia related complications, using the area under the receiver operating characteristics curves (AUC), which evaluates how well the model discriminate between patients who had a pneumonia related complication or not. RESULTS: A total of 491 patients with CAP were enrolled, 256 being admitted to the hospital and 235 treated as outpatients. Admitted patients had higher biomarker levels than outpatients (p < 0.001). The SCAP score and pro-ADM level had the best AUCs for predicting pneumonia related complications (0.83 and 0.84, respectively). Considering SCAP score plus pro-ADM level, the AUC increased significantly to 0.88. SCAP score class 0 or 1 with a pro-ADM level <0.5 ng/mL was the best indicator for selecting patients for outpatient care. CONCLUSIONS: A new risk score combining SCAP score with pro-ADM level is useful to classify severity risk in CAP patients and hence supporting decision-making on hospital admission.
Subject(s)
Adrenomedullin/blood , Community-Acquired Infections/complications , Community-Acquired Infections/diagnosis , Pneumonia/complications , Pneumonia/diagnosis , Protein Precursors/blood , Adult , Aged , Aged, 80 and over , Ambulatory Care , Area Under Curve , Biomarkers/blood , C-Reactive Protein/analysis , C-Reactive Protein/isolation & purification , Calcitonin/blood , Calcitonin Gene-Related Peptide , Community-Acquired Infections/blood , Emergency Service, Hospital , Female , Hospitalization , Humans , Male , Middle Aged , Pneumonia/blood , Predictive Value of Tests , Prognosis , Prospective Studies , ROC Curve , Severity of Illness IndexABSTRACT
The availability of an easily measurable specific marker for diagnosis of a disease is an important but not always reachable objective. Emergency area is an area where decisions must be taken as quick as possible, and sometimes it is not clear if the patient is well enough to be treated as an outpatient or must be hospitalized. During last few years many new biomarkers and techniques for their measurement have been developed, and surely some others will appear. The aim of this report was to present TRACE technology for specific assays such as: copeptin, proadrenomedullin and proatrial natriuretic peptide. Ongoing research is being done to decide in which diseases they might be useful and if they will be needed for diagnosis, prognosis or treatment monitoring. Results are not conclusive yet, but in the future some of these markers could be used in routine laboratory work if their utility is documented by new data.
