Chest
Original ResearchCommunity-Acquired PneumoniaMidregional Proadrenomedullin as a Prognostic Tool in Community-Acquired Pneumonia
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Study Design and Setting
We conducted a multicenter, prospective cohort study of patients presenting to the EDs of 28 teaching and nonteaching hospitals in southwestern Pennsylvania, Connecticut, southern Michigan, and western Tennessee between November 2001 and November 2003 (Genetic and Inflammatory Markers of Sepsis [GenIMS]). GenIMS investigated the relationship between inflammatory molecule expression, clinical course, and outcome in patients with CAP and sepsis. As part of this aim, we sought to determine the
Baseline Characteristics
Of the 2,320 subjects enrolled in GenIMS, 1,653 (71.3%) had an MR-proADM level measured on the presenting day and formed the study cohort (Fig 1). Median time from ED admission to first blood sample collection was 1.3 h. Table 1 lists the baseline characteristics of the study cohort. We had complete ED PSI data in 1,385 of the 1,653 cohort subjects (84%). Subjects were predominantly white, and 39% were identified as being at high risk by PSI, with most subjects admitted to the hospital. The
Discussion
Our findings confirm the prognostic value of MR-proADM in patients with CAP, but we also note important differences from the original Swiss study. Although we also found that MR-proADM strongly correlated with PSI and mortality, we identified a lower optimal cutoff value in our study cohort. Furthermore, we observed that the prognostic utility of MR-proADM beyond PSI was limited to high-risk subjects.
Differences in study cohort and methodology may explain the differing findings. Our study
Conclusions
In our multicenter CAP cohort, MR-proADM level correlated with severity of illness and death. High MR-proADM levels offer additional risk stratification in high-risk CAP patients, but otherwise MR-proADM levels do not alter PSI-based risk assessment in most CAP patients.
Acknowledgments
Author contributions: Drs. Huang, Angus, Weissfeld, Kellum, and Yealy conceived and designed the study, analyzed and interpreted the data, and provided important critical revisions of the article. Drs. Huang, Angus, and Yealy drafted the article. Drs. Huang, Angus, Kellum, and Yealy provided final approval. Dr. Weissfeld and Mr. Pugh provided statistical expertise, and they contributed to the analysis and interpretation of the data and the drafting of the article. Dr. Struck provided technical
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Funding/Support: Funding for this research was received from National Institute of General Medical Sciences grant No. R01 GM061992.
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