Pneumology Service, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain.
Pneumology Service, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain.
J Infect. 2015 May;70(5):457-66. doi: 10.1016/j.jinf.2014.12.003. Epub 2014 Dec 11.
We sought to evaluate the usefulness of biomarkers-procalcitonin (PCT), C-reactive protein (CRP) and proadrenomedullin (pro-ADM)-combined with prognostic scales (PSI, CURB-65 and SCAP score) for identifying adverse outcomes in patients with community-acquired pneumonia (CAP) attending at an Emergency Department (ED).
Prospective observational study in a teaching hospital among patients with CAP. In addition to collecting data for the prognostic scales, samples were taken at the ED for assessing PCT, CRP and pro-ADM levels. We compared the prognostic accuracy of these biomarkers with severity scores to predict pneumonia related complications, using the area under the receiver operating characteristics curves (AUC), which evaluates how well the model discriminate between patients who had a pneumonia related complication or not.
A total of 491 patients with CAP were enrolled, 256 being admitted to the hospital and 235 treated as outpatients. Admitted patients had higher biomarker levels than outpatients (p < 0.001). The SCAP score and pro-ADM level had the best AUCs for predicting pneumonia related complications (0.83 and 0.84, respectively). Considering SCAP score plus pro-ADM level, the AUC increased significantly to 0.88. SCAP score class 0 or 1 with a pro-ADM level <0.5 ng/mL was the best indicator for selecting patients for outpatient care.
A new risk score combining SCAP score with pro-ADM level is useful to classify severity risk in CAP patients and hence supporting decision-making on hospital admission.
我们旨在评估生物标志物-降钙素原（PCT）、C 反应蛋白（CRP）和前肾上腺髓质素（pro-ADM）与预后评分（PSI、CURB-65 和 SCAP 评分）相结合，用于识别在急诊就诊的社区获得性肺炎（CAP）患者的不良结局。
这是一项在教学医院进行的前瞻性观察性研究，针对 CAP 患者。除了收集预后评分的数据外，还在急诊室采集样本以评估 PCT、CRP 和 pro-ADM 水平。我们比较了这些生物标志物与严重程度评分的预后准确性，以使用接收者操作特征曲线下面积（AUC）预测肺炎相关并发症，该指标评估模型区分患有肺炎相关并发症或不患有肺炎相关并发症的患者的能力。
共纳入 491 例 CAP 患者，其中 256 例住院，235 例门诊治疗。住院患者的生物标志物水平高于门诊患者（p<0.001）。SCAP 评分和 pro-ADM 水平预测肺炎相关并发症的 AUC 最高（分别为 0.83 和 0.84）。考虑到 SCAP 评分加 pro-ADM 水平，AUC 显著增加至 0.88。SCAP 评分 0 或 1 级且 pro-ADM 水平<0.5ng/mL 是选择门诊治疗患者的最佳指标。
结合 SCAP 评分和 pro-ADM 水平的新风险评分可用于对 CAP 患者的严重程度风险进行分类，从而支持住院决策。
