肾上腺髓质素可优化慢性阻塞性肺疾病患者的死亡率预测。
Adrenomedullin optimises mortality prediction in COPD patients.
作者信息
Brusse-Keizer Marjolein, Zuur-Telgen Maaike, van der Palen Job, VanderValk Paul, Kerstjens Huib, Boersma Wim, Blasi Francesco, Kostikas Konstantinos, Milenkovic Branislava, Tamm Michael, Stolz Daiana
机构信息
Medical School Twente, Medisch Spectrum Twente, Enschede, The Netherlands.
Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, The Netherlands.
出版信息
Respir Med. 2015 Jun;109(6):734-42. doi: 10.1016/j.rmed.2015.02.013. Epub 2015 Mar 6.
BACKGROUND
Current multicomponent scores that predict mortality in COPD patients might underestimate the systemic component of COPD. Therefore, we evaluated the accuracy of circulating levels of proadrenomedullin (MR-proADM) alone or combined with the ADO (Age, Dyspnoea, airflow Obstruction), updated ADO or BOD (Body mass index, airflow Obstruction, Dyspnoea) index to predict all-cause mortality in stable COPD patients.
METHODS
This study pooled data of 1285 patients from the COMIC and PROMISE-COPD study.
RESULTS
Patients with high MR-proADM levels (≥0.87 nmol/l) had a 2.1 fold higher risk of dying than those with lower levels (p < 0.001). Based on the C-statistic, the ADOA index (ADO plus MR-proADM) (C = 0.72) was the most accurate predictor followed by the BODA (BOD plus MR-proADM) (C = 0.71) and the updated ADOA index (updated ADO plus MR-proADM) (C = 0.70). Adding MR-proADM to ADO and BOD was superior in forecasting 1- and 2-year mortality. The net percentages of persons with events correctly reclassified (NRI+) within respectively 1-year and 2-year was 31% and 20% for ADO, 31% and 20% for updated ADO and 25% and 19% for BOD. The net percentages of persons without events correctly reclassified (NRI-) within respectively 1-year and 2-year was 26% and 27% for ADO, 27% and 28% for updated ADO and 34% and 34% for BOD.
CONCLUSIONS
Adding MR-proADM increased the predictive power of BOD, ADO and updated ADO index.
背景
目前用于预测慢性阻塞性肺疾病（COPD）患者死亡率的多组分评分可能低估了COPD的全身因素。因此，我们评估了单独的前肾上腺髓质素（MR-proADM）循环水平或与ADO（年龄、呼吸困难、气流阻塞）、更新后的ADO或BOD（体重指数、气流阻塞、呼吸困难）指数联合使用来预测稳定期COPD患者全因死亡率的准确性。
方法
本研究汇总了来自COMIC和PROMISE-COPD研究的1285例患者的数据。
结果
MR-proADM水平高（≥0.87 nmol/l）的患者死亡风险比水平低的患者高2.1倍（p < 0.001）。基于C统计量，ADOA指数（ADO加MR-proADM）（C = 0.72）是最准确的预测指标，其次是BODA（BOD加MR-proADM）（C = 0.71）和更新后的ADOA指数（更新后的ADO加MR-proADM）（C = 0.70）。将MR-proADM添加到ADO和BOD中在预测1年和2年死亡率方面更具优势。ADO在1年和2年内事件正确重新分类的净百分比（NRI+）分别为31%和20%，更新后的ADO为31%和20%，BOD为25%和19%。ADO在1年和2年内无事件正确重新分类的净百分比（NRI-）分别为26%和27%，更新后的ADO为27%和28%，BOD为34%和34%。
结论
添加MR-proADM可提高BOD、ADO和更新后的ADO指数的预测能力。
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