Pereira J M, Azevedo A, Basílio C, Sousa-Dias C, Mergulhão P, Paiva J A
Emergency and Intensive Care Department, Centro Hospitalar São João EPE, Porto, Portugal; Department of Medicine, University of Porto Medical School, Porto, Portugal.
Hospital Epidemiology Centre, Centro Hospitalar São João EPE, Porto, Portugal; Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Portugal; EPIUnit - Institute of Public Health, University of Porto, Portugal.
Rev Port Pneumol (2006). 2016 Nov-Dec;22(6):308-314. doi: 10.1016/j.rppnen.2016.03.012. Epub 2016 May 6.
Mid-regional proadrenomedullin (MR-proADM) is a novel biomarker with potential prognostic utility in patients with community-acquired pneumonia (CAP).
To evaluate the value of MR-proADM levels at ICU admission for further severity stratification and outcome prediction, and its kinetics as an early predictor of response in severe CAP (SCAP).
Prospective, single-center, cohort study of 19 SCAP patients admitted to the ICU within 12h after the first antibiotic dose.
At ICU admission median MR-proADM was 3.58nmol/l (IQR: 2.83-10.00). No significant association was found between its serum levels at admission and severity assessed by SAPS II (Spearman's correlation=0.24, p=0.31) or SOFA score (SOFA<10: <3.45nmol/l vs. SOFA≥10: 3.90nmol/l, p=0.74). Hospital and one-year mortality were 26% and 32%, respectively. No significant difference in median MR-proADM serum levels was found between survivors and non-survivors and its accuracy to predict hospital mortality was bad (aROC 0.53). After 48h of antibiotic therapy, MR-proADM decreased in all but 5 patients (median -20%; IQR -56% to +0.1%). Its kinetics measured by the percent change from baseline was a good predictor of clinical response (aROC 0.80). The best discrimination was achieved by classifying patients according to whether MR-proADM decreased or not within 48h. No decrease in MR-proADM serum levels significantly increased the chances of dying independently of general severity (SAPS II-adjusted OR 174; 95% CI 2-15,422; p=0.024).
In SCAP patients, a decrease in MR-proADM serum levels in the first 48h after ICU admission was a good predictor of clinical response and better outcome.
中段肾上腺髓质素原（MR-proADM）是一种新型生物标志物，对社区获得性肺炎（CAP）患者具有潜在的预后评估价值。
评估重症监护病房（ICU）入院时MR-proADM水平在进一步严重程度分层和预后预测中的价值，以及其动态变化作为重症CAP（SCAP）患者反应早期预测指标的作用。
对19例在首次使用抗生素后12小时内入住ICU的SCAP患者进行前瞻性、单中心队列研究。
ICU入院时，MR-proADM中位数为3.58nmol/l（四分位数间距：2.83 - 10.00）。入院时其血清水平与用简化急性生理学评分系统II（SAPS II）评估的严重程度（Spearman相关性 = 0.24，p = 0.31）或序贯器官衰竭评估（SOFA）评分（SOFA<10：<3.45nmol/l 对比 SOFA≥10：3.90nmol/l，p = 0.74）之间未发现显著关联。住院死亡率和1年死亡率分别为26%和32%。幸存者和非幸存者的MR-proADM血清水平中位数无显著差异，其预测住院死亡率的准确性较差（曲线下面积为0.53）。抗生素治疗48小时后，除5例患者外，其余患者的MR-proADM均下降（中位数 -20%；四分位数间距 -56%至 +0.1%）。以相对于基线的变化百分比衡量的其动态变化是临床反应的良好预测指标（曲线下面积为0.80）。根据MR-proADM在48小时内是否下降对患者进行分类，可实现最佳区分。MR-proADM血清水平未下降显著增加死亡几率，且与总体严重程度无关（经SAPS II校正的比值比为174；95%置信区间为2 - 15422；p = 0.024）。
在SCAP患者中，ICU入院后首48小时内MR-proADM血清水平下降是临床反应和较好预后的良好预测指标。
