NIHR Newcastle In Vitro Diagnostics Co-operative, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, UK.
Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
BMJ Open. 2019 Feb 22;8(11):e020337. doi: 10.1136/bmjopen-2017-020337.
To assess the value added to the National Early Warning Score (NEWS) by mid-regional pro-adrenomedullin (MR-proADM) blood level in predicting deterioration in mild to moderately ill people.
Prospective observational study.
The Medical Admissions Suite of the Royal Victoria Infirmary, Newcastle.
300 adults with NEWS between 2 and 5 on admission. Exclusion criteria included receiving palliative care, or admitted for social reasons or self-harming. Patients were enrolled between September and December 2015, and followed up for 30 days after discharge.
The primary outcome measure was the proportion of patients who, within 72 hours, had an , defined as any combination of an increase of at least 2 in the NEWS; transfer to a higher-dependency bed or monitored area; death; or for those discharged from hospital, readmission for medical reasons.
NEWS and MR-proADM together predicted more accurately than NEWS alone, increasing the area under the curve (AUC) to 0.61 (95% CI 0.54 to 0.69) from 0.55 (95% CI 0.48 to 0.62). When the confounding effects of presence of chronic obstructive pulmonary disease or heart failure and interaction with MR-proADM were included, the prognostic accuracy further increased the AUC to 0.69 (95% CI 0.63 to 0.76).
MR-proADM is potentially a clinically useful biomarker for deterioration in patients admitted to hospital with a mild to moderately severe acute illness, that is, with NEWS between 2 and 5. As a growing number of National Health Service hospitals are routinely recording the NEWS on their clinical information systems, further research should assess the practicality and use of developing a decision aid based on admission NEWS, MR-proADM level, and possibly other clinical data and other biomarkers that could further improve prognostic accuracy.
评估中区域促肾上腺皮质素原（MR-proADM）血水平对 NEWS 评分预测轻度至中度疾病患者恶化的附加价值。
前瞻性观察研究。
纽卡斯尔皇家维多利亚医院的医疗收治套房。
300 名入院时 NEWS 在 2 至 5 分之间的成年人。排除标准包括接受姑息治疗、因社会原因或自残而入院的患者。患者于 2015 年 9 月至 12 月期间入组，并在出院后 30 天进行随访。
主要结局指标是在 72 小时内出现下列情况的患者比例，定义为 NEWS 至少增加 2 分；转入更高依赖床位或监测区域；死亡；或对于从医院出院的患者，因医疗原因再次入院。
NEWS 和 MR-proADM 联合预测比 NEWS 单独预测更准确，曲线下面积（AUC）从 0.55（95%CI 0.48 至 0.62）增加到 0.61（95%CI 0.54 至 0.69）。当纳入慢性阻塞性肺疾病或心力衰竭的存在以及与 MR-proADM 的相互作用的混杂效应时，预测准确性进一步提高 AUC 至 0.69（95%CI 0.63 至 0.76）。
MR-proADM 可能是一种临床上有用的生物标志物，可用于预测 NEWS 评分为 2 至 5 的轻度至中度急性疾病患者的病情恶化。随着越来越多的国民保健服务医院常规在其临床信息系统上记录 NEWS，应进一步研究开发基于入院 NEWS、MR-proADM 水平以及可能其他临床数据和其他生物标志物的决策辅助工具的实用性和使用，以进一步提高预测准确性。
