Servicio de Neumología, Hospital Universitario Miguel Servet, Zaragoza, , Spain.
Eur Respir J. 2012 May;39(5):1144-55. doi: 10.1183/09031936.00080411. Epub 2011 Nov 10.
Biomarkers are useful in community-acquired pneumonia (CAP). Recently, midregional (MR) proadrenomedullin (proADM) has been shown to be of potential prognostic use. We sought to determine whether this prognostic role depends on the cause of CAP. We conducted a prospective cohort study of immunocompetent patients with CAP. Pneumonia Severity Index (PSI) and CURB-65 score (confusion (abbreviated mental test score of ≤ 8), urea ≥ 7 mol · L(-1), respiratory rate ≥ 30 breaths · min(-1), blood pressure <90 mmHg systolic or <60 mmHg diastolic, and age ≥ 65 yrs), blood C-reactive protein, procalcitonin, MR-proADM, and microbiological studies were systematically performed. Patients were grouped as bacterial, viral/atypical and mixed CAP, and were followed up at 30, 90 and 180 days, and 1 yr. We recruited 228 CAP patients. Identification of at least one pathogen was achieved in 155 (68%) patients. MR-proADM levels closely correlated with increasing severity scores, and showed an important predictive power for complications and short- and long-term mortality (1 yr). Its addition to PSI and CURB-65 significantly improved their prognostic accuracy. A MR-proADM cut-off of 0.646 nmol · L(-1) identified 92% of patients scored as PSI classes IV and V as high risk. MR-proADM outcome prediction power was not affected by different aetiologies. MR-proADM has high short- and long-term prognostic accuracy, and increases the accuracy of clinical scores. The prognostic value of MR-proADM is not modified by different possible CAP aetiologies.
生物标志物在社区获得性肺炎（CAP）中很有用。最近，中区域（MR）原促肾上腺皮质素（proADM）已被证明具有潜在的预后作用。我们试图确定这种预后作用是否取决于 CAP 的病因。我们进行了一项免疫功能正常的 CAP 患者的前瞻性队列研究。肺炎严重指数（PSI）和 CURB-65 评分（意识障碍（简短精神测试评分≤8）、尿素≥7 mol·L（-1）、呼吸频率≥30 次·分钟（-1）、血压收缩压<90mmHg 或舒张压<60mmHg，年龄≥65 岁）、血 C 反应蛋白、降钙素原、MR-proADM 和微生物学研究进行了系统检查。患者分为细菌性、病毒性/非典型性和混合性 CAP，并在 30、90 和 180 天以及 1 年进行随访。我们招募了 228 例 CAP 患者。在 155 例（68%）患者中至少发现了一种病原体。MR-proADM 水平与严重程度评分的增加密切相关，并对并发症和短期及长期死亡率（1 年）具有重要的预测能力。将其添加到 PSI 和 CURB-65 中，显著提高了它们的预后准确性。MR-proADM 截断值为 0.646nmol·L（-1），可识别 92%PSI 评分 IV 级和 V 级的患者为高危。MR-proADM 的预后预测能力不受不同病因的影响。MR-proADM 具有较高的短期和长期预后准确性，并提高了临床评分的准确性。MR-proADM 的预后价值不受不同的 CAP 病因的影响。
