Mid-regional proadrenomedullin: An early marker of response in critically ill patients with severe community-acquired pneumonia?

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• 作者：J.M. Pereira^a ; ^b ; ^{jmcrpereira@yahoo.com} ; A. Azevedo^c ; ^d ; ^e ; C. Basí ; lio^a ; C. Sousa-Dias^a ; P. Mergulhã ; o^a ; ^b ; J.A. Paiva^a ; ^b
• 关键词：CAP ; community-acquired pneumonia ; ICU ; Intensive Care Unit ; COPD ; Chronic Obstructive Pulmonary Disease ; SAPS ; Simplified Acute Physiology Score ; PIRO ; Predisposition ; Insult ; Response ; Organ failure ; SOFA ; Sepsis-related Organ Failure Assessment ; PSI ; Pneumonia Severity Index ; MR-proADM ; mid-regional proadrenomedullin ; SD ; standard deviation ; IQR ; interquartile range ; ROC ; receiver operating characteristics ; aROC ; area under the receiver operating characteristics curve
• 刊名：Revista Portuguesa de Pneumologia (English Edition)
• 出版年：2016
• 出版时间：November-December 2016
• 年：2016
• 卷：22
• 期：6
• 页码：308-314
• 全文大小：425 K
• 卷排序：22

文摘

Mid-regional proadrenomedullin (MR-proADM) is a novel biomarker with potential prognostic utility in patients with community-acquired pneumonia (CAP).PurposeTo evaluate the value of MR-proADM levels at ICU admission for further severity stratification and outcome prediction, and its kinetics as an early predictor of response in severe CAP (SCAP).Materials and methodsProspective, single-center, cohort study of 19 SCAP patients admitted to the ICU within 12 h after the first antibiotic dose.ResultsAt ICU admission median MR-proADM was 3.58 nmol/l (IQR: 2.83–10.00). No significant association was found between its serum levels at admission and severity assessed by SAPS II (Spearman's correlation = 0.24, p = 0.31) or SOFA score (SOFA < 10: <3.45 nmol/l vs. SOFA ≥ 10: 3.90 nmol/l, p = 0.74). Hospital and one-year mortality were 26% and 32%, respectively. No significant difference in median MR-proADM serum levels was found between survivors and non-survivors and its accuracy to predict hospital mortality was bad (aROC 0.53). After 48 h of antibiotic therapy, MR-proADM decreased in all but 5 patients (median −20%; IQR −56% to +0.1%). Its kinetics measured by the percent change from baseline was a good predictor of clinical response (aROC 0.80). The best discrimination was achieved by classifying patients according to whether MR-proADM decreased or not within 48 h. No decrease in MR-proADM serum levels significantly increased the chances of dying independently of general severity (SAPS II-adjusted OR 174; 95% CI 2–15,422; p = 0.024).ConclusionsIn SCAP patients, a decrease in MR-proADM serum levels in the first 48 h after ICU admission was a good predictor of clinical response and better outcome.