Proadrenomedullin (ProADM) confers additional prognostic information to established clinical risk scores in lower respiratory tract infections (LRTI). We aimed to derive a practical algorithm combining the CURB65 score with ProADM-levels in patients with community-acquired pneumonia (CAP) and non-CAP-LRTI

AM Neill

B Leff

B Muller

Barbara Reutlinger

Beat Mueller

CL Chang

CM Coley

CP Escalante

D Aujesky

DM Yealy

DT Huang

FH Yap

Frank Dusemund

J Struck

KL Becker

Kristina Rüegger

LA Mandell

M Briel

M Christ-Crain

M Loeb

M Woodhead

MD Howell

Mirjam Christ-Crain

MJ Fine

MS Niederman

NG Morgenthaler

NM Siafakas

P Linscheid

P Schuetz

Philipp Schuetz

PM Calverley

R Gonzales

S Ewig

S Ross

S Shepperd

Sarosh Irani

Thomas Bregenzer

TJ Marrie

Ulrich Buergi

Werner C Albrich

Werner Zimmerli

WS Lim

ZY Aliyu

English

PubMed

Abstract Background Proadrenomedullin (ProADM) confers additional prognostic information to established clinical risk scores in lower respiratory tract infections (LRTI). We aimed to derive a practical algorithm combining the CURB65 score with ProADM-levels in patients with community-acquired pneumonia (CAP) and non-CAP-LRTI. Methods We used data of 1359 patients with LRTI enrolled in a multicenter study. We chose two ProADM cut-off values by assessing the association between ProADM levels and the risk of adverse events and mortality. A composite score (CURB65-A) was created combining CURB65 classes with ProADM cut-offs to further risk-stratify patients. Results CURB65 and ProADM predicted both adverse events and mortality similarly well in CAP and non-CAP-LRTI. The combined CURB65-A risk score provided better prediction of death and adverse events than the CURB65 score in the entire cohort and in CAP and non-CAP-LRTI patients. Within each CURB65 class, higher ProADM-levels were associated with an increased risk of adverse events and mortality. Overall, risk of adverse events (3.9%) and mortality (0.65%) was low for patients with CURB65 score 0-1 and ProADM ≤0.75 nmol/l (CURB65-A risk class I); intermediate (8.6% and 2.6%, respectively) for patients with CURB65 score of 2 and ProADM ≤1.5 nmol/l or CURB classes 0-1 and ProADM levels between 0.75-1.5 nmol/L (CURB65-A risk class II), and high (21.6% and 9.8%, respectively) for all other patients (CURB65-A risk class III). If outpatient treatment was recommended for CURB65-A risk class I and short hospitalization for CURB65-A risk class II, 17.9% and 40.8% of 1217 hospitalized patients could have received ambulatory treatment or a short hospitalization, respectively. Conclusions The new CURB65-A risk score combining CURB65 risk classes with ProADM cut-off values accurately predicts adverse events and mortality in patients with CAP and non-CAP-LRTI. Additional prospective cohort or intervention studies need to validate this score and demonstrate its safety and efficacy for the management of patients with LRTI. Trial Registration Procalcitonin-guided antibiotic therapy and hospitalisation in patients with lower respiratory tract infections: the prohosp study; isrctn.org Identifier: ISRCTN: ISRCTN95122877</p

Buergi Ulrich

Irani Sarosh

Bregenzer Thomas

Zimmerli Werner

Christ-Crain Mirjam

Rüegger Kristina

Dusemund Frank

Albrich Werner C

Reutlinger Barbara

Mueller Beat

Schuetz Philipp

Directory of Open Access Journals

BMC Infectious Diseases

Enhancement of CURB65 score with proadrenomedullin (CURB65-A) for outcome prediction in lower respiratory tract infections: Derivation of a clinical algorithm

Background: Proadrenomedullin (ProADM) confers additional prognostic information to established clinical risk scores in lower respiratory tract infections (LRTI). We aimed to derive a practical algorithm combining the CURB65 score with ProADM-levels in patients with community-acquired pneumonia (CAP) and non-CAP-LRTI. Methods: We used data of 1359 patients with LRTI enrolled in a multicenter study. We chose two ProADM cut-off values by assessing the association between ProADM levels and the risk of adverse events and mortality. A composite score (CURB65-A) was created combining CURB65 classes with ProADM cut-offs to further risk-stratify patients. Results: CURB65 and ProADM predicted both adverse events and mortality similarly well in CAP and non-CAP-LRTI. The combined CURB65-A risk score provided better prediction of death and adverse events than the CURB65 score in the entire cohort and in CAP and non-CAP-LRTI patients. Within each CURB65 class, higher ProADM-levels were associated with an increased risk of adverse events and mortality. Overall, risk of adverse events (3.9%) and mortality (0.65%) was low for patients with CURB65 score 0-1 and ProADM \(\leq\)0.75 nmol/l (CURB65-A risk class I); intermediate (8.6% and 2.6%, respectively) for patients with CURB65 score of 2 and ProADM \(\leq\)1.5 nmol/l or CURB classes 0-1 and ProADM levels between 0.75-1.5 nmol/L (CURB65-A risk class II), and high (21.6% and 9.8%, respectively) for all other patients (CURB65-A risk class III). If outpatient treatment was recommended for CURB65-A risk class I and short hospitalization for CURB65-A risk class II, 17.9% and 40.8% of 1217 hospitalized patients could have received ambulatory treatment or a short hospitalization, respectively. Conclusions: The new CURB65-A risk score combining CURB65 risk classes with ProADM cut-off values accurately predicts adverse events and mortality in patients with CAP and non-CAP-LRTI. Additional prospective cohort or intervention studies need to validate this score and demonstrate its safety and efficacy for the management of patients with LRTI. Trial Registration: Procalcitonin-guided antibiotic therapy and hospitalisation in patients with lower respiratory tract infections: the prohosp study; isrctn.org Identifier: ISRCTN: ISRCTN95122877Version of Recor

Albrich, Werner C

Dusemund, Frank

Christ-Crain, Mirjam

Zimmerli, Werner

Bregenzer, Thomas

Irani, Sarosh

Buergi, Ulrich

Mueller, Beat

Ruegger, Kristina

Reutlinger, Barbara

Schuetz, Philipp

Harvard University - DASH

Enhancement of CURB65 Score with Proadrenomedullin (CURB65-A) for Outcome Prediction in Lower Respiratory Tract Infections: Derivation of a Clinical Algorithm

Albrich, Werner C.

Rüegger, Kristina

edoc

Enhancement of CURB65 score with proadrenomedullin (CURB65-A) for outcome prediction in lower respiratory tract infections: derivation of a clinical algorithm

Abstract
          
            Background
            Proadrenomedullin (ProADM) confers additional prognostic information to established clinical risk scores in lower respiratory tract infections (LRTI). We aimed to derive a practical algorithm combining the CURB65 score with ProADM-levels in patients with community-acquired pneumonia (CAP) and non-CAP-LRTI.
          
          
            Methods
            We used data of 1359 patients with LRTI enrolled in a multicenter study. We chose two ProADM cut-off values by assessing the association between ProADM levels and the risk of adverse events and mortality. A composite score (CURB65-A) was created combining CURB65 classes with ProADM cut-offs to further risk-stratify patients.
          
          
            Results
            CURB65 and ProADM predicted both adverse events and mortality similarly well in CAP and non-CAP-LRTI. The combined CURB65-A risk score provided better prediction of death and adverse events than the CURB65 score in the entire cohort and in CAP and non-CAP-LRTI patients. Within each CURB65 class, higher ProADM-levels were associated with an increased risk of adverse events and mortality. Overall, risk of adverse events (3.9%) and mortality (0.65%) was low for patients with CURB65 score 0-1 and ProADM ≤0.75 nmol/l (CURB65-A risk class I); intermediate (8.6% and 2.6%, respectively) for patients with CURB65 score of 2 and ProADM ≤1.5 nmol/l or CURB classes 0-1 and ProADM levels between 0.75-1.5 nmol/L (CURB65-A risk class II), and high (21.6% and 9.8%, respectively) for all other patients (CURB65-A risk class III). If outpatient treatment was recommended for CURB65-A risk class I and short hospitalization for CURB65-A risk class II, 17.9% and 40.8% of 1217 hospitalized patients could have received ambulatory treatment or a short hospitalization, respectively.
          
          
            Conclusions
            The new CURB65-A risk score combining CURB65 risk classes with ProADM cut-off values accurately predicts adverse events and mortality in patients with CAP and non-CAP-LRTI. Additional prospective cohort or intervention studies need to validate this score and demonstrate its safety and efficacy for the management of patients with LRTI.
          
          
            Trial Registration
            Procalcitonin-guided antibiotic therapy and hospitalisation in patients with lower respiratory tract infections: the prohosp study; isrctn.org Identifier: ISRCTN: ISRCTN95122877
            
          </jats:sec

Crossref

Springer - Publisher Connector

A: Identification of an Adrenomedullin precursor fragment in plasma of sepsis patients. Peptides

A: Measurement of midregional proadrenomedullin in plasma with an immunoluminometric assay. Clinical chemistry

AD: Avoiding hospital admission through provision of hospital care at home: a systematic review and meta-analysis of individual patient data. Cmaj

al: Guidelines for the management of adults with community-acquired pneumonia. Diagnosis, assessment of severity, antimicrobial therapy, and prevention. American journal of respiratory and critical care medicine

Autocrine/paracrine role of inflammation-mediated calcitonin gene-related peptide and adrenomedullin expression in human adipose tissue. Endocrinology

BG: A controlled trial of a critical pathway for treatment of communityacquired pneumonia. CAPITAL Study Investigators. Community-Acquired Pneumonia Intervention Trial Assessing Levofloxacin. Jama

Biomarkers in the management of pneumonia. Expert review of respiratory medicine

Calcitonin precursors are reliable markers of sepsis in a medical intensive care unit. Critical care medicine

Chronic obstructive pulmonary disease. Lancet

Circulating precursor levels of endothelin-1 and adrenomedullin, two endothelium-derived, counteracting substances, in sepsis. Endothelium

Clinical review 167: Procalcitonin and the calcitonin gene family of peptides in inflammation, infection, and sepsis: a journey from calcitonin back to its precursors. The Journal of clinical endocrinology and metabolism

De Geest S, et al: Which patients with lower respiratory tract infections need inpatient treatment? Perceptions of physicians, nurses, patients and relatives. BMC pulmonary medicine 10:12.

DE: Preferences for home vs hospital care among low-risk patients with community-acquired pneumonia. Archives of internal medicine

Determinants for hospitalization in “ low-risk” community acquired pneumonia. BMC infectious diseases

et al: Community acquired pneumonia: aetiology and usefulness of severity criteria on admission. Thorax

et al: Effect of increasing the intensity of implementing pneumonia guidelines: a randomized, controlled trial. Annals of internal medicine

et al: Effect of procalcitonin-based Albrich et al.

et al: Hospital at home: feasibility and outcomes of a program to provide hospital-level care at home for acutely ill older patients. Annals of internal medicine

et al: Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis

et al: Optimal assessment and management of chronic obstructive pulmonary disease (COPD). The European Respiratory Society Task Force. Eur Respir J

et al: Outcomes of treatment pathways in outpatient treatment of low risk febrile neutropenic cancer patients. Support Care Cancer

et al: Procalcitonin guided antibiotic therapy and hospitalization in patients with lower respiratory tract infections: a prospective, multicenter, randomized controlled trial. BMC health services research

et al: Prohormones for prediction of adverse medical outcome in community-acquired pneumonia and lower respiratory tract infections. Critical care (London,

Hancox RJ: Predicting Early Mortality in Acute Exacerbation of Chronic Obstructive Pulmonary Disease using the CURB65 score. Respirology

Huang JQ: Admission is not always necessary for patients with community-acquired pneumonia in risk classes IV and V diagnosed in the emergency room. Can Respir J

JT: Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax

Marrie T: Effect of a clinical pathway to reduce hospitalizations in nursing home residents with pneumonia: a randomized controlled trial. Jama

Marrie TJ: Burden of community-acquired pneumonia in North American adults.

Mid-regional pro-adrenomedullin as a prognostic marker in sepsis: an observational study. Critical care (London,

Niederman MS, Torres A: Severe community-acquired pneumonia. Assessment of severity criteria.

Peiris JS: Excess hospital admissions for pneumonia, chronic obstructive pulmonary disease, and heart failure during influenza seasons in Hong Kong. Journal of medical virology

Predicting mortality with pneumonia severity scores: importance of model recalibration to local settings. Epidemiology and infection

Pro-adrenomedullin to predict severity and outcome in community-acquired pneumonia [ISRCTN04176397]. Critical care (London,

Procalcitonin and other biomarkers to improve assessment and antibiotic stewardship in infections–hope for hype? Swiss Med Wkly

Procalcitonin-guided antibiotic use vs a standard approach for acute respiratory tract infections in primary care. Archives of internal medicine

Reasons why emergency department providers do not rely on the pneumonia severity index to determine the initial site of treatment for patients with pneumonia. Clin Infect Dis

Saikku P: Study of community acquired pneumonia aetiology (SCAPA) in adults admitted to hospital: implications for management guidelines. Thorax

Shapiro NI: Performance of severity of illness scoring systems in emergency department patients with infection. Acad Emerg Med

The Pneumonia Severity Index score: time to move to a prospective study of patients with community-acquired pneumonia who are discharged from emergency departments to be managed on an ambulatory basis. Clin Infect Dis

Uncomplicated acute bronchitis. Annals of internal medicine

Verheij TJ: Guidelines for the management of adult lower respiratory tract infections. Eur Respir J

WN: A prediction rule to identify low-risk patients with community-acquired pneumonia. The New England journal of medicine

Yealy DM: Midregional proadrenomedullin as a prognostic tool in community-acquired pneumonia. Chest

http://doaj.org/search?source=%7B%22query%22%3A%7B%22bool%22%3A%7B%22must%22%3A%5B%7B%22term%22%3A%7B%22id%22%3A%2276c4a0e85e124ad284f9a483a3a47f60%22%7D%7D%5D%7D%7D%7D

Enhancement of CURB65 score with proadrenomedullin (CURB65-A) for outcome prediction in lower respiratory tract infections: Derivation of a clinical algorithm

Abstract

Similar works

Full text

Available Versions

Directory of Open Access Journals

Harvard University - DASH

edoc

Crossref

Springer - Publisher Connector

Springer - Publisher Connector