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Original Research: COMMUNITY-ACQUIRED PNEUMONIA |

Midregional Proadrenomedullin as a Prognostic Tool in Community-Acquired Pneumonia

David T. Huang, MD, MPH; Derek C. Angus, MD, MPH, FCCP; John A. Kellum, MD; Nathan A. Pugh, BS; Lisa A. Weissfeld, PhD; Joachim Struck, PhD; Russell L. Delude, PhD; Matthew R. Rosengart, MD, MPH; Donald M. Yealy, MD
Author and Funding Information

Affiliations: From the Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Laboratory (Drs. Huang, Angus, Kellum, Weissfeld, Delude, Rosengart, and Yealy), the Departments of Critical Care Medicine (Drs. Huang, Angus, Kellum, Delude, and Rosengart), Emergency Medicine (Drs. Huang and Yealy), and Surgery (Dr. Rosengart), and the Department of Biostatistics (Mr. Pugh and Dr. Weissfeld), Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA; and the Research Department (Dr. Struck), BRAHMS AG, Biotechnology Centre, Hennigsdorf, Germany.

Correspondence to: David T. Huang, MD, MPH, University of Pittsburgh, Critical Care Medicine, 646B Scaife Hall, Pittsburgh, PA 15261; e-mail: huangdt@ccm.upmc.edu


Funding for this research was received from National Institute of General Medical Sciences grant No. R01 GM061992.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;136(3):823-831. doi:10.1378/chest.08-1981
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Background:  Midregional proadrenomedullin (MR-proADM) is a potential prognostic biomarker in patients with community-acquired pneumonia (CAP). Previous work has been hampered by sample size and illness spectrum limits. We sought to describe the pattern of MR-proADM in a broad CAP cohort, confirm its prognostic role, and compare its performance to procalcitonin, a novel biomarker of infection.

Methods:  We conducted a multicenter prospective cohort study in 28 community and teaching EDs. Patients with a clinical and radiographic diagnosis of CAP were enrolled. We stratified MR-proADM levels a priori into quartiles and quantified severity of illness using the pneumonia severity index (PSI); and confusion (abbreviated mental test score of ≤ 8), urea ≥ 7 mmol/L, respiratory rate ≥ 30 breaths/min, BP < 90 mm Hg systolic or < 60 mm Hg diastolic, age ≥ 65 years (CURB-65). The primary outcome was 30-day mortality.

Results:  A total of 1,653 patients formed the study cohort. MR-proADM levels consistently rose with PSI class and 30-day mortality (p < 0.001). MR-proADM had a higher area under the curve for 30-day mortality than procalcitonin (0.76 vs 0.65, respectively; p < 0.001), but adding MR-proADM to the PSI in all subjects minimally improved performance. Among low-risk subjects (PSI classes I to III), mortality was low and did not differ by MR-proADM quartile. However, among high-risk subjects (PSI class IV/V; n = 546), subjects in the highest MR-proADM quartile (n = 232; 42%) had higher 30-day mortality than those in MR-proADM quartiles 1 to 3 (23% vs 9%, respectively; p < 0.0001). Similar results were seen with CURB-65. MR-proADM and procalcitonin levels were generally concordant; only 6% of PSI class IV/V subjects in the highest MR-proADM quartile had very low procalcitonin levels (< 0.1 ng/mL).

Conclusions:  In our multicenter CAP cohort, MR-proADM levels correlate with increasing 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.

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