Widmer Daniel, Drozdov Daniel, Rüegger Kristina, Litke Alexander, Arici Birsen, Regez Katharina, Guglielmetti Merih, Schild Ursula, Conca Antoinette, Schäfer Petra, Kouegbe Rita Bossart, Reutlinger Barbara, Blum Claudine, Schuetz Philipp, Irani Sarosh, Huber Andreas, Bürgi Ulrich, Müller Beat, Albrich Werner C
Medical University Department, University of Basel, Kantonsspital Aarau, Tellstrasse, Aarau 5001, Switzerland.
Department of Clinical Nursing Science, Kantonsspital Aarau, Tellstrasse, Aarau 5001, Switzerland.
J Clin Med. 2014 Mar 14;3(1):267-79. doi: 10.3390/jcm3010267.
An intervention trial found a trend for shorter length of stay (LOS) in patients with community-acquired pneumonia (CAP) when the CURB65 score was combined with the prognostic biomarker proadrenomedullin (ProADM) (CURB65-A). However, the efficacy and safety of CURB65-A in real life situations remains unclear.
From September, 2011, until April, 2012, we performed a post-study prospective observational quality control survey at the cantonal Hospital of Aarau, Switzerland of consecutive adults with CAP. The primary endpoint was length of stay (LOS) during the index hospitalization and within 30 days. We compared the results with two well-defined historic cohorts of CAP patients hospitalized in the same hospital with the use of multivariate regression, namely 83 patients in the observation study without ProADM (OPTIMA I) and the 169 patients in the intervention study (OPTIMA II RCT).
A total of 89 patients with confirmed CAP were included. As compared to patients with CURB65 only observed in the OPTIMA I study, adjusted regression analysis showed a significant shorter initial LOS (7.5 vs. 10.4 days; -2.32; 95% CI, -4.51 to -0.13; p = 0.04) when CURB65-A was used in clinical routine. No significant differences were found for LOS within 30 days. There were no significant differences in safety outcomes in regard to mortality and ICU admission between the cohorts.
This post-study survey provides evidence that the use of ProADM in combination with CURB65 (CURB65-A) in "real life" situations reduces initial LOS compared to the CURB65 score alone without apparent negative effects on patient safety.
一项干预试验发现，当CURB65评分与预后生物标志物前肾上腺髓质素（ProADM）联合使用（CURB65-A）时，社区获得性肺炎（CAP）患者的住院时间（LOS）有缩短的趋势。然而，CURB65-A在实际临床中的疗效和安全性仍不明确。
从2011年9月至2012年4月，我们在瑞士阿劳州立医院对连续收治的成年CAP患者进行了一项研究后前瞻性观察性质量控制调查。主要终点是首次住院期间及30天内的住院时间（LOS）。我们使用多变量回归将结果与在同一医院住院的两个明确的CAP患者历史队列进行比较，即观察研究中83例未使用ProADM的患者（OPTIMA I）和干预研究中的169例患者（OPTIMA II RCT）。
共纳入89例确诊为CAP的患者。与仅在OPTIMA I研究中观察到的CURB65患者相比，调整后的回归分析显示，在临床常规使用CURB65-A时，初始住院时间显著缩短（7.5天对10.4天；-2.32；95%CI，-4.51至-0.13；p = 0.04）。30天内的住院时间无显著差异。各队列在死亡率和ICU入院等安全性结局方面无显著差异。
这项研究后调查提供了证据，即在“实际临床环境”中，与单独使用CURB65评分相比，联合使用ProADM与CURB65（CURB65-A）可缩短初始住院时间，且对患者安全无明显负面影响。
