Pro-adrenomedullin to predict severity and outcome in community-acquired pneumonia [ISRCTN04176397]
Mirjam Christ-Crain,Nils G. Morgenthaler,Daiana Stolz,Christian Müller,Roland Bingisser,Stéphan Juergen Harbarth,Michael Tamm,Joachim Struck,Andreas Bergmann,Beat Müller +9 more
TLDR
ProADM, as a novel biomarker, is a useful tool for the risk stratification of patients with CAP, and increased with increasing severity of CAP.Abstract:
Pro-adrenomedullin (proADM) is helpful for individual risk assessment and outcome prediction in sepsis. A major cause of sepsis is community-acquired pneumonia (CAP). The aim of this study was to investigate the value of proADM levels for severity assessment and outcome prediction in CAP. Data from 302 patients admitted to the emergency department with CAP were included in a prospective observational study. Procalcitonin, C-reactive protein levels, leukocyte count, clinical variables and the pneumonia severity index (PSI) were measured. ProADM levels were measured with a new sandwich immunoassay for mid regional ProADM (MR-proADM, Brahms AG, Hennigsdorf/Berlin, Germany). ProADM levels, in contrast to C-reactive protein and leukocyte count, increased with increasing severity of CAP, classified according to the PSI score (ANOVA, p < 0.001). In patients who died during follow-up, proADM levels on admission were significantly higher compared to levels in survivors (2.1 (1.5 to 3.0) versus 1.0 (0.6 to 1.6) nmol/l, p < 0.001). In a receiver operating characteristic (ROC) analysis for survival, the area under the ROC curve (AUC) for proADM was 0.76 (95% confidence interval (CI) 0.71–0.81), which was significantly higher compared to procalcitonin (p = 0.004), C-reactive protein (p < 0.001) and total leukocyte count (p = 0.001) and similar to the AUC of the PSI (0.73, p = 0.54). A clinical model including the PSI and proADM increased the prognostic accuracy to predict failure compared to a model relying on the PSI alone (AUC, 0.77 (0.70 to 0.84), p = 0.03). ProADM, as a novel biomarker, is a useful tool for the risk stratification of patients with CAP.read more
Citations
More filters
Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia the official statement of the American Thoracic Society and the Infectious Disease Society of America (特集 救急診療ガイドライン) -- (海外のガイドライン)
TL;DR: The Methodology used to Prepare the Guideline Epidemiology Incidence Etiology and Recommendations for Assessing Response to Therapy Suggested Performance Indicators is summarized.
Journal ArticleDOI
BTS guidelines for the management of community acquired pneumonia in adults: update 2009.
Wei Shen Lim,S V Baudouin,R C George,Adam T. Hill,C Jamieson,I Le Jeune,John Macfarlane,Robert C. Read,H J Roberts,Mark L Levy,M Wani,Mark Woodhead +11 more
TL;DR: A summary of the initial management of patients admitted to hospital with suspected community acquired pneumonia (CAP) is presented and the relevant microbiological investigations and empirical antibiotic choices recommended in patients with CAP are summarized.
Journal ArticleDOI
Guidelines for the management of adult lower respiratory tract infections
TL;DR: The guidelines cover the breadth of adult community-acquired respiratory infection, including prevention (both vaccine- and nonvaccine-related), infections in the community and infections in those admitted to hospital, including pneumonia, exacerbations of chronic obstructive pulmonary disease (COPD) and exacerbation of bronchiectasis.
Journal ArticleDOI
Guidelines for the management of adult lower respiratory tract infections ‐ Full version
Mark Woodhead,Francesco Blasi,Santiago Ewig,Javier Garau,G. Huchon,Margareta Ieven,Åke Örtqvist,Tom Schaberg,Antoni Torres,G. H. M. van der Heijden,Robert C. Read,Th J M Verheij +11 more
TL;DR: This document is an update of Guidelines published in 2005 and now includes scientific publications through to May 2010 that provides evidence-based recommendations for the most common management questions occurring in routine clinical practice in the management of adult patients with LRTI.
References
More filters
Journal ArticleDOI
Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults
Lionel A. Mandell,Richard G. Wunderink,Antonio Anzueto,John G. Bartlett,G. Douglas Campbell,Nathan C. Dean,Nathan C. Dean,Scott F. Dowell,Daniel M. Musher,Daniel M. Musher,Michael S. Niederman,Michael S. Niederman,Antoni Torres,Cynthia G. Whitney,Michael E. DeBakey Veterans +14 more
TL;DR: This work presents a meta-analyses of the immune system’s response to chronic obstructive pulmonary disease and shows clear patterns of decline in the immune systems of elderly patients with compromised immune systems.
Journal ArticleDOI
A prediction rule to identify low-risk patients with community-acquired pneumonia
Michael J. Fine,Thomas E. Auble,Donald M. Yealy,Barbara H. Hanusa,Lisa A. Weissfeld,Daniel E. Singer,Christopher M. Coley,Thomas J. Marrie,Wishwa N. Kapoor +8 more
TL;DR: A prediction rule that stratifies patients into five classes with respect to the risk of death within 30 days accurately identifies the patients with community-acquired pneumonia who are at low risk for death and other adverse outcomes and may help physicians make more rational decisions about hospitalization for patients with pneumonia.
Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia the official statement of the American Thoracic Society and the Infectious Disease Society of America (特集 救急診療ガイドライン) -- (海外のガイドライン)
TL;DR: The Methodology used to Prepare the Guideline Epidemiology Incidence Etiology and Recommendations for Assessing Response to Therapy Suggested Performance Indicators is summarized.