Francesco Travaglino1, Veronica Russo2, Benedetta De Berardinis3, Filippo Numeroso4, Pamela Catania5, Gianfranco Cervellin6, Stefano Geniere Nigra7, Francesco Geraci8, Maria Antonietta Bressan9, Stefania Guerrini10, Mario Cavazza11, Christian Folli12, Valter Monzani13, Stefania Battista14, Giulio Mengozzi15, Paola Noto16, Giuseppe Carpinteri17, Andrea Semplicini18, Federica Stella19, Stella Ingrassia20, Paolo Moscatelli21, Patrizia Giuntini22, Gerardo Salerno23, Patrizia Cardelli24, Salvatore Di Somma25. 1. Emergency Department, Sant'Andrea Hospital, School of Medicine and Psychology "Sapienza" Univesity, Rome, Italy. Electronic address: francesco.travaglino@gmail.com. 2. Emergency Department, Sant'Andrea Hospital, School of Medicine and Psychology "Sapienza" Univesity, Rome, Italy. Electronic address: veryo85@hotmail.it. 3. Emergency Department, Sant'Andrea Hospital, School of Medicine and Psychology "Sapienza" Univesity, Rome, Italy. Electronic address: benedetta.db@gmail.com. 4. Emergency Medicine Department, Parma Teaching Hospital, Parma, Italy. Electronic address: FNumeroso@ao.pr.it. 5. Emergency Medicine Department, Parma Teaching Hospital, Parma, Italy. Electronic address: pamelacatania@live.com. 6. Emergency Medicine Department, Parma Teaching Hospital, Parma, Italy. Electronic address: GCervellin@ao.pr.it. 7. Emergency Medicine Department, San Matteo Teaching Hospital, Pavia, Italy. Electronic address: stefano.genierenigra@email.it. 8. Emergency Medicine Department, San Matteo Teaching Hospital, Pavia, Italy. Electronic address: francescogeraci@gmail.com. 9. Emergency Medicine Department, San Matteo Teaching Hospital, Pavia, Italy. Electronic address: m.bressan@smatteo.pv.it. 10. Emergency Medicine Department, S. Orsola-Malpighi Teaching Hospital, Bologna, Italy. Electronic address: stefania.guerrini@aosp.bo.it. 11. Emergency Medicine Department, S. Orsola-Malpighi Teaching Hospital, Bologna, Italy. Electronic address: mario.cavazza@aosp.bo.it. 12. Emergency Medicine Department, Maggiore Teaching Hospital, Milan, Italy. Electronic address: christian.folli@policlinico.mi.it. 13. Emergency Medicine Department, Maggiore Teaching Hospital, Milan, Italy. Electronic address: vmonzani@policlinico.mi.it. 14. Emergency Medicine Department, Città della Scienza e della Salute Hospital, Turin, Italy. Electronic address: stefania.battista@libero.it. 15. Emergency Medicine Department, Città della Scienza e della Salute Hospital, Turin, Italy. Electronic address: gmengozzi@cittadellasalute.to.it. 16. Emergency Medicine Department, Vittorio Emanuele Teaching Hospital, Catania, Italy. Electronic address: p.noto@hotmail.it. 17. Emergency Medicine Department, Vittorio Emanuele Teaching Hospital, Catania, Italy. Electronic address: gcarpinteri@gmail.com. 18. Internal Medicine Department, SS Giovanni e Paolo Hospital in Venice, University of Padua, Italy. Electronic address: andrea.semplicini@unipd.it. 19. Internal Medicine Department, SS Giovanni e Paolo Hospital in Venice, University of Padua, Italy. Electronic address: fede.stella@gmail.com. 20. Emergency Medicine Department, San Martino Teaching Hospital, Cenoa University, Italy. Electronic address: stella99@alice.it. 21. Emergency Medicine Department, San Martino Teaching Hospital, Cenoa University, Italy. Electronic address: moscatellievandro@gmail.com. 22. Emergency Medicine Department, San Martino Teaching Hospital, Cenoa University, Italy. Electronic address: patriziagiuntini53@gmail.com. 23. Clinical and Molecular Medicine Department Sant'Andrea Hospital, School of Medicine and Psychology "Sapienza" Univesity, Rome, Italy. Electronic address: sagerardo@libero.it. 24. Clinical and Molecular Medicine Department Sant'Andrea Hospital, School of Medicine and Psychology "Sapienza" Univesity, Rome, Italy. Electronic address: patrizia.cardelli@uniroma1.it. 25. Emergency Department, Sant'Andrea Hospital, School of Medicine and Psychology "Sapienza" Univesity, Rome, Italy. Electronic address: salvatore.disomma@uniroma1.it.
Abstract
INTRODUCTION: Mid-regional pro-atrial natriuretic peptide (MR-proANP), procalcitonin (PCT), and mid-regional pro-adrenomedullin (MR-proADM) demonstrated usefulness for management of emergency department patients with dyspnea. METHODS: To evaluate in patients with dyspnea, the prognostic value for 30 and 90 days mortality and readmission of PCT, MR-proADM, and MR-proANP, a multicenter prospective study was performed evaluating biomarkers at admission, 24 and 72 hours after admission. Based on final diagnosis, patients were divided into acute heart failure (AHF), primary lung diseases, or both (AHF + NO AHF). RESULTS: Five hundred one patients were enrolled. Procalcitonin and MR-proADM values at admission and at 72 hours were significantly (P < .001) predictive for 30-day mortality: baseline PCT with an area under the curve (AUC) of 0.70 and PCT at 72 hours with an AUC of 0.61; baseline MR-proADM with an AUC of 0.62 and MR-proADM at 72 hours with an AUC of 0.68. As for 90-day mortality, both PCT and MR-proADM baseline and 72 hours values showed a significant (P < .0001) predictive ability: baseline PCT with an AUC of 0.73 and 72 hours PCT with an AUC of 0.64; baseline MR-proADM with an AUC of 0.66 and 72 hours MR-proADM with an AUC of 0.71. In AHF, group biomarkers predicted rehospitalization and mortality at 90 days, whereas in AHF + NO AHF group, they predict mortality at 30 and 90 days. CONCLUSIONS: In patients admitted for dyspnea, assessment of PCT plus MR-proADM improves risk stratification and management. Combined use of biomarkers is able to predict in the total cohort both rehospitalization and death at 30 and 90 days.
INTRODUCTION: Mid-regional pro-atrial natriuretic peptide (MR-proANP), procalcitonin (PCT), and mid-regional pro-adrenomedullin (MR-proADM) demonstrated usefulness for management of emergency department patients with dyspnea. METHODS: To evaluate in patients with dyspnea, the prognostic value for 30 and 90 days mortality and readmission of PCT, MR-proADM, and MR-proANP, a multicenter prospective study was performed evaluating biomarkers at admission, 24 and 72 hours after admission. Based on final diagnosis, patients were divided into acute heart failure (AHF), primary lung diseases, or both (AHF + NO AHF). RESULTS: Five hundred one patients were enrolled. Procalcitonin and MR-proADM values at admission and at 72 hours were significantly (P < .001) predictive for 30-day mortality: baseline PCT with an area under the curve (AUC) of 0.70 and PCT at 72 hours with an AUC of 0.61; baseline MR-proADM with an AUC of 0.62 and MR-proADM at 72 hours with an AUC of 0.68. As for 90-day mortality, both PCT and MR-proADM baseline and 72 hours values showed a significant (P < .0001) predictive ability: baseline PCT with an AUC of 0.73 and 72 hours PCT with an AUC of 0.64; baseline MR-proADM with an AUC of 0.66 and 72 hours MR-proADM with an AUC of 0.71. In AHF, group biomarkers predicted rehospitalization and mortality at 90 days, whereas in AHF + NO AHF group, they predict mortality at 30 and 90 days. CONCLUSIONS: In patients admitted for dyspnea, assessment of PCT plus MR-proADM improves risk stratification and management. Combined use of biomarkers is able to predict in the total cohort both rehospitalization and death at 30 and 90 days.
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Authors: Ya-Nan Zhang; Flora Vernooij; Irwani Ibrahim; Shirley Ooi; Crystel M Gijsberts; Arjan H Schoneveld; Kuan Win Sen; Hester M den Ruijter; Leo Timmers; Arthur Mark Richards; Chun Tzen Jong; Ibrahim Mazlan; Jiong-Wei Wang; Carolyn S P Lam; Dominique P V de Kleijn Journal: PLoS One Date: 2016-01-28 Impact factor: 3.240