[中段前肾上腺髓质素（MR-proADM）预测急诊科疑似感染成年患者临床预后不良及分层预后的能力]

[Ability of midregional proadrenomedullin (MR-proADM) to predict poor clinical outcome and stratify prognosis in adult patients seen for suspected infection in the Emergency Department].

作者信息

de Rafael-González Elena, Cabañas-Morafraile Javier, Serrano-Martín Laura, Julián-Jiménez Agustín, Torres-Fernández María, Chaves-Prieto Elia, Morell-Jurado Laura, López-Forero William Esneider, Calafell-Mas María Francisca, Cordero Álvaro Thomas-Balaguer, Asensio-Nieto María Remedios, Nieto-Rojas Isabel, Rubio-Díaz Rafael, Heredero-Gálvez Eva, Lorenzo-Lozano María Carmen, Canabal-Berlanga Raúl

机构信息

Servicio de Análisis Clínicos y Bioquímica, Complejo Hospitalario Universitario de Toledo, IDISCAM, Toledo, España.

Servicio de Urgencias, Complejo Hospitalario Universitario de Toledo, IDISCAM, Toledo, España.

出版信息

Rev Esp Quimioter. 2025 May 27;38(4):319-334. doi: 10.37201/req/031.2025.

DOI:10.37201/req/031.2025

PMID:40432452

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12257179/

Abstract

OBJECTIVES

To analyze and compare the accuracy of midregional proadrenomedullin (MR-proADM) to predict poor clinical outcome (understood as progression to septic shock or admission to the Critical Care Unit -CCU-) and 30-day mortality in adult patients seen for suspected infection in the Emergency Department (ED). We also compared their performance with other biomarkers (C-reactive protein -CRP-, procalcitonin -PCT-, lactate and leukocyte count) and clinical scales widely used in routine practice (qSOFA, SRIS, NEWS-2).

METHODS

A prospective, observational and analytical study was carried out on adult patients who were treated in an ED with the clinical diagnosis of an infectious process. Follow-up was carried out for 30 days. The main outcome was a composite measure that included progression to septic shock or admission to the CCU and 30-day mortality. The predictive ability was analyzed with the area under the curve (AUC) of the receiver operating characteristic (ROC) and the values of sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of MR-proADM, PCR, PCT, lactate, leukocyte count and the clinical scales.

RESULTS

214 patients were included, of whom 31 (14.5%) fulfilled the combined variable. The mean age was 68.6 (SD 20.75) years, 55.1% (118) were men. The MR-proADM concentration achieved the best AUC-ROC of 0.920 (95% CI: 0.850-0.989) compared to the other biomarkers and clinical scales. With a cut-off point (Cp) according to the Youden index > 2.105 nmol/L, a Se: 68%, Es: 98% and NPV: 97% were obtained. The NEWS-2 scale ≥ 5 achieves an AUC-ROC of 0.733 (95% CI: 0.630-0.835) with a Se: 87%, Es: 55% and NPV: 96%. The mixed model (MR-proADM ≥2.1 nmol/l + NEWS-2 ≥5) improved the AUC-ROC to 0.849 (95% CI: 0.782-0.915) and Se: 68%, Es: 98%, PPV: 74% and NPV: 88%.

CONCLUSIONS

In adult patients attended with clinical suspicion of infection in the ED, MR-proADM presents a high ability to predict poor clinical evolution (progression to septic shock or ICU admission) and 30-day mortality and performs better than PCT, lactate, CRP, leukocyte count and the clinical scales qSOFA, SRIS, NEWS-2. The combined model (MR-proADM ≥2.1 nmol/L + NEWS-2 ≥5) improves prediction of both MR-proADM and clinical scales.

摘要

目的

分析并比较中段肾上腺髓质素原（MR-proADM）预测成年急诊患者（ED）疑似感染时不良临床结局（定义为进展为感染性休克或入住重症监护病房 -CCU-）及30天死亡率的准确性。我们还将其与其他生物标志物（C反应蛋白 -CRP-、降钙素原 -PCT-、乳酸和白细胞计数）以及常规临床广泛使用的临床量表（qSOFA、SRIS、NEWS-2）的性能进行比较。

方法

对在ED接受治疗且临床诊断为感染性疾病的成年患者进行前瞻性、观察性和分析性研究。随访30天。主要结局是一个综合指标，包括进展为感染性休克或入住CCU以及30天死亡率。通过受试者操作特征曲线（ROC）的曲线下面积（AUC）以及MR-proADM、PCR、PCT、乳酸、白细胞计数和临床量表的敏感性（Se）、特异性（Sp）、阳性预测值（PPV）和阴性预测值（NPV）来分析预测能力。

结果

纳入214例患者，其中31例（14.5%）符合综合变量。平均年龄为68.6（标准差20.75）岁，55.1%（118例）为男性。与其他生物标志物和临床量表相比，MR-proADM浓度的AUC-ROC最佳，为0.920（95%可信区间：0.850 - 0.989）。根据约登指数确定的截断点（Cp）>2.105 nmol/L时，敏感性为68%，特异性为98%，阴性预测值为97%。NEWS-2量表≥5时，AUC-ROC为0.733（95%可信区间：0.630 - 0.835），敏感性为87%，特异性为55%，阴性预测值为96%。混合模型（MR-proADM≥2.1 nmol/l + NEWS-2≥5）将AUC-ROC提高到0.849（95%可信区间：0.782 - 0.915），敏感性为68%，特异性为98%，阳性预测值为74%，阴性预测值为88%。

结论

在ED中临床怀疑感染的成年患者中，MR-proADM具有较高的预测不良临床进展（进展为感染性休克或入住ICU）及30天死亡率的能力，并且比PCT、乳酸、CRP、白细胞计数以及临床量表qSOFA、SRIS、NEWS-2表现更好。联合模型（MR-proADM≥2.1 nmol/L + NEWS-2≥5）提高了MR-proADM和临床量表的预测能力。