Bertrand Renaud1, Philipp Schuetz2, Yann-Erick Claessens3, José Labarère4, Werner Albrich5, Beat Mueller5. 1. Service d'urgence, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor-Albert Chenevier, Créteil, France; Université Paris Est Créteil, Faculté de Médecine, Créteil, France. Electronic address: bertrand.renaud@hmn.aphp.fr. 2. Harvard School of Public Health, Boston, MA. 3. Department of Emergency Medicine, Centre Hospitalier Princesse Grace, Monaco. 4. Techniques de l'Ingénierie Médicale et de la Complexité, Unité Mixte de Recherche 5525 Centre National de Recherche Scientifique Université Joseph Fourier-Grenoble 1, Grenoble, France. 5. Medical University Clinic, Kantonsspital Aarau, Switzerland.
Abstract
BACKGROUND: Whether proadrenomedullin (ProADM) improves the performance of the Risk of Early Admission to ICU (REA-ICU) score in predicting early, severe community-acquired pneumonia (ESCAP) has not been demonstrated. METHODS: Secondary analysis was completed of the original data from 877 consecutive patients with community-acquired pneumonia (CAP) enrolled in the Procalcitonin-Guided Antibiotic Therapy and Hospitalization in Patients With Lower Respiratory Tract Infections (ProHOSP) study, a multicenter trial in EDs of six tertiary-care hospitals in Switzerland. ESCAP was defined by either the requirement for mechanical ventilation or vasopressive drugs or occurrence of death within 3 days of ED presentation. RESULTS: Eighty patients (9.1%) developed ESCAP (47 required mechanical ventilation, 19 vasopressive drugs, and 16 died) within 3 days of ED presentation. They had a higher median ProADM value (2.18 nmol/L vs 1.15 nmol/L, P < .001). Combining ProADM testing with the REA-ICU score improved the area under the curve (0.81) compared with either parameter (ProADM [0.73] or REA-ICU score [0.76], P < .001) and resulted in a net reclassification improvement of 0.20 (P < .001). A ProADM value ≥ 1.8 nmol/L or assignment to REA-ICU risk classes III-IV predicted ESCAP with a sensitivity of 76.3% and a negative predictive value of 96.7%. Excluding 21 patients with major criteria of severe CAP on presentation showed similar results. CONCLUSION: These study findings demonstrate that the addition of ProADM to the REA-ICU score improves the classification of a substantial proportion of patients in the ED at intermediate or high risk for ESCAP, which may translate into better triage decisions.
BACKGROUND: Whether proadrenomedullin (ProADM) improves the performance of the Risk of Early Admission to ICU (REA-ICU) score in predicting early, severe community-acquired pneumonia (ESCAP) has not been demonstrated. METHODS: Secondary analysis was completed of the original data from 877 consecutive patients with community-acquired pneumonia (CAP) enrolled in the Procalcitonin-Guided Antibiotic Therapy and Hospitalization in Patients With Lower Respiratory Tract Infections (ProHOSP) study, a multicenter trial in EDs of six tertiary-care hospitals in Switzerland. ESCAP was defined by either the requirement for mechanical ventilation or vasopressive drugs or occurrence of death within 3 days of ED presentation. RESULTS: Eighty patients (9.1%) developed ESCAP (47 required mechanical ventilation, 19 vasopressive drugs, and 16 died) within 3 days of ED presentation. They had a higher median ProADM value (2.18 nmol/L vs 1.15 nmol/L, P < .001). Combining ProADM testing with the REA-ICU score improved the area under the curve (0.81) compared with either parameter (ProADM [0.73] or REA-ICU score [0.76], P < .001) and resulted in a net reclassification improvement of 0.20 (P < .001). A ProADM value ≥ 1.8 nmol/L or assignment to REA-ICU risk classes III-IV predicted ESCAP with a sensitivity of 76.3% and a negative predictive value of 96.7%. Excluding 21 patients with major criteria of severe CAP on presentation showed similar results. CONCLUSION: These study findings demonstrate that the addition of ProADM to the REA-ICU score improves the classification of a substantial proportion of patients in the ED at intermediate or high risk for ESCAP, which may translate into better triage decisions.
Authors: Katherine Adams; Mark W Tenforde; Shreya Chodisetty; Benjamin Lee; Eric J Chow; Wesley H Self; Manish M Patel Journal: Hum Vaccin Immunother Date: 2021-11-10 Impact factor: 3.452
Authors: Philipp Schuetz; Natalie Friedli; Eva Grolimund; Alexander Kutz; Sebastian Haubitz; Mirjam Christ-Crain; Robert Thomann; Werner Zimmerli; Claus Hoess; Christoph Henzen; Beat Mueller Journal: Diabetologia Date: 2013-11-24 Impact factor: 10.122
Authors: Philipp Schuetz; Pierre Hausfater; Devendra Amin; Sebastian Haubitz; Lukas Fässler; Eva Grolimund; Alexander Kutz; Ursula Schild; Zeljka Caldara; Katharina Regez; Andriy Zhydkov; Timo Kahles; Krassen Nedeltchev; Stefanie von Felten; Sabina De Geest; Antoinette Conca; Petra Schäfer-Keller; Andreas Huber; Mario Bargetzi; Ulrich Buergi; Gabrielle Sauvin; Pasqualina Perrig-Chiello; Barbara Reutlinger; Beat Mueller Journal: BMC Emerg Med Date: 2013-07-04
Authors: Susana Gordo-Remartínez; María Calderón-Moreno; Juan Fernández-Herranz; Ana Castuera-Gil; Mar Gallego-Alonso-Colmenares; Carolina Puertas-López; José A Nuevo-González; Domingo Sánchez-Sendín; Mercedes García-Gámiz; José A Sevillano-Fernández; Luis A Álvarez-Sala; Juan A Andueza-Lillo; José M de Miguel-Yanes Journal: PLoS One Date: 2015-06-01 Impact factor: 3.240
Authors: Todd A Florin; Lilliam Ambroggio; Cole Brokamp; Yin Zhang; Eric S Nylen; Mantosh Rattan; Eric Crotty; Michael A Belsky; Sara Krueger; Thomas N Epperson; Andrea Kachelmeyer; Richard M Ruddy; Samir S Shah Journal: Clin Infect Dis Date: 2021-08-02 Impact factor: 9.079