Multiple sclerosis: diagnostic optimism.

Abstract

<b><i>Background</i></b> Proadrenomedullin (proADM) has been shown to be a good predictor for mortality in stable state. This study aims to provide an external validation of earlier observed cutoff values used by Zuur-Telgen et al. and Stolz.et al. in stable state and at hospitalization for an AECOPD. <b><i>Methods</i></b> From the COMIC study we included respectively 490 and 101 COPD patients with a blood sample obtained in stable state and at hospitalization for an AECOPD. Time to death was compared between patients with proADM above or below the median of 0.71 and 0.75 nmol/L for stable state or 0.79 and 0.84 nmol/l for AECOPD. The predictive value of proADM for survival was determined by calculating the C statistic. Risk ratios were corrected for gender, age, BMI, heart failure and GOLD stage. <b><i>Results</i></b> Patients above the cut-off of 0.75 nmol/l had a 2 fold higher risk of dying than patient below this cut-off (95% CI: 1.20 – 3.41). The cut-off of 0.71 nmol/l showed only a borderline significant higher risk of 1.67 (95% CI: 0.98 – 2.85). The Odds Ratio corrected for one year mortality was 3.15 (95% CI 1.15 – 8.64) and 3.70 (95% CI 1.18 – 11.6) in patients with proADM levels above the cut-off of 0.75 and 0.71 nmol/l measured in stable state respectively, compared to patients with low levels (table 2). ProADM levels in samples at hospitalization for an AECOPD were not predictive for mortality in this validation cohort. <b><i>Conclusions</i></b> ProADM shows to be a powerful predictor for mortality in stable state. The following step will be the comparison with other multi-component indices such as the BODE and ADO. Furthermore, proADM could be used for risk stratification in controlled trials to optimize therapy for survival prolonging.