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Original Research: Critical Care |

Proadrenomedullin Improves Risk of Early Admission to ICU Score for Predicting Early Severe Community-Acquired PneumoniaPredicting Severe Community-Acquired Pneumonia

Bertrand Renaud, MD; Philipp Schuetz, MD; Yann-Erick Claessens, MD; José Labarère, MD; Werner Albrich, MD; Beat Mueller, MD
Author and Funding Information

From the Service d’urgence (Dr Renaud), Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor-Albert Chenevier, Créteil, France; Université Paris Est Créteil (Dr Renaud), Faculté de Médecine, Créteil, France; Harvard School of Public Health (Dr Schuetz), Boston, MA; Department of Emergency Medicine (Dr Claessens), Centre Hospitalier Princesse Grace, Monaco; Techniques de l’Ingénierie Médicale et de la Complexité (Dr Labarère), Unité Mixte de Recherche 5525 Centre National de Recherche Scientifique Université Joseph Fourier-Grenoble 1, Grenoble, France; Medical University Clinic (Drs Albrich and Mueller), Kantonsspital Aarau, Switzerland.

Correspondence to: Bertrand Renaud, MD, Service d’Urgence, Hôpital Henri Mondor, 51 Avenue du Maréchal Delattre de Tassigny, F-94000, Créteil, France; e-mail: bertrand.renaud@hmn.aphp.fr


Drs Renaud and Schuetz contributed equally to this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

Funding/Support: The initial trial was supported by the Swiss National Science Foundation [Grant SNF 3200BO-116177/1]. Dr Schuetz was supported by a research grant from the Swiss Foundation for Grants in Biology and Medicine [Schweizerische Stiftung für medizinisch-biologische Stipendien, PASMP3-127684/1].


Chest. 2012;142(6):1447-1454. doi:10.1378/chest.11-2574
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Background:  Whether proadrenomedullin (ProADM) improves the performance of the Risk of Early Admission to ICU (REA-ICU) score in predicting early, severe community-acquired pneumonia (ESCAP) has not been demonstrated.

Methods:  Secondary analysis was completed of the original data from 877 consecutive patients with community-acquired pneumonia (CAP) enrolled in the Procalcitonin-Guided Antibiotic Therapy and Hospitalization in Patients With Lower Respiratory Tract Infections (ProHOSP) study, a multicenter trial in EDs of six tertiary-care hospitals in Switzerland. ESCAP was defined by either the requirement for mechanical ventilation or vasopressive drugs or occurrence of death within 3 days of ED presentation.

Results:  Eighty patients (9.1%) developed ESCAP (47 required mechanical ventilation, 19 vasopressive drugs, and 16 died) within 3 days of ED presentation. They had a higher median ProADM value (2.18 nmol/L vs 1.15 nmol/L, P < .001). Combining ProADM testing with the REA-ICU score improved the area under the curve (0.81) compared with either parameter (ProADM [0.73] or REA-ICU score [0.76], P < .001) and resulted in a net reclassification improvement of 0.20 (P < .001). A ProADM value ≥ 1.8 nmol/L or assignment to REA-ICU risk classes III-IV predicted ESCAP with a sensitivity of 76.3% and a negative predictive value of 96.7%. Excluding 21 patients with major criteria of severe CAP on presentation showed similar results.

Conclusion:  These study findings demonstrate that the addition of ProADM to the REA-ICU score improves the classification of a substantial proportion of patients in the ED at intermediate or high risk for ESCAP, which may translate into better triage decisions.

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