Abstract
Introduction: Various biomarkers are used to evaluate the severity and prognosis of community acquired pneumonia (CAP).Objectives: To study and compare the prognostic value of MR-proADM, РСТ and CRP in predicting the severity and outcome of CAP.Methods: A prospective cohort study of 92 patients hospitalized with CAP in the Clinic of Pneumology and Phthisiatrics of MHAT “Saint Marina”–Varna in 2015 was conducted. The biomarkers were measured on admission. Midregional pro-adrenomedullin (MR-proADM) and procalcitonin (РСТ) were measured by standard ELISA, and C-reactive protein (CRP) was determined by latex-enhanced immunoturbidimetric assay. CAP severity was assessed by CURB-65.Results: Patients were on average 59.2±16.8 years of age; 68.5% of them were male. The in-hospital mortality rate was 7.6%. The three biomarkers MR-proADM, РСТ and CRP were significantly higher in non-survivors compared to survivors (0.918±0.045 ng/ml vs. 0.397±0.269ng/ml, р<0.001; 2.14±0.60ng/ml vs. 1.12±0.68ng/ml, р<0.001 and 215.12±96.39 mg/L vs.175.74±221.5mg/L, p<0.05 respectively). In patients who needed intensive care, the biomarkers were also significantly higher than those in patients treated in the general hospital unit (0.509±0.336ng/ml vs. 0.414±0.28ng/ml, р<0.05; 1.92±0.76 ng/ml vs. 1.15±0.70ng/ml, p<0.05 and 221.98±100.34 mg/L vs. 165.31±122.84 mg/L, p<0.05 resp.). MR-proADM and РСТ showed a moderate correlation with the CURB-65 (r=0.33, p<0.01 and r=0.30, p<0.05 respectively). CRP did not correlate with the CURB-65 (r=0.10, p>0.05).Conclusion: MR-proADM, РСТ and CRP were significantly higher in non-survivors and in patients treated in the intensive care unit. MR-proADM and РСТ showed a moderate correlation with the CURB-65, while the correlation coefficient for MR-proADM was higher. CRP did not correlate with the CURB-65.
Highlights
Various biomarkers are used to evaluate the severity and prognosis of community acquired pneumonia (CAP)
The patients were on average 59.2±16.8 years of age; 63 (68.5%) of them were male and 29 (31.5%) were female. 22 patients (23.9%) were treated in the intensive care unit (ICU). 7 patients (7.6%) died during hospital stay
We established that MR-proADM and РСТ showed a moderate correlation with the CURB-65 score (r=0.33, p
Summary
Various biomarkers are used to evaluate the severity and prognosis of community acquired pneumonia (CAP). Various biomarkers are in use for evaluation of the severity and prognosis of community acquired pneumonia (CAP) Some of them, such as C-reactive protein (CRP) and, in some hospitals procalcitonin (PCT), are used routinely in clinical practice, but others, such as pro-adrenomedullin have been recently studied in an attempt to find better prognostic tools in CAP. CRP was discovered in 1930 by Tillet and Francis It is an acute-phase protein, which is an early and sensitive, but nonspecific marker of systemic inflammation. РСТ is the precursor of the active hormone calcitonin It belongs to CALC-1 – gene family. Its levels begin to rise within 2 hours after bacterial infection which makes it earlier marker than CRP. Its levels rise in pneumonia, acute inhalation poisoning and other severe infections such as pancreatitis, appendicitis, burns, heat stroke, multiple trauma, surgeries (Becker et al, 2010)
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