Role of serum proadrenomedullin in assessment of the severity and outcome of hospitalized healthcare-associated pneumonia patients

Amany Shaker,Hany A Labib,Doaa Mostafa Gad,Sameh Embarak

doi:10.4103/1687-8426.145702

Abstract

Background Clinical judgment of healthcare-associated pneumonia ( HCAP ) represents a major concern as these fragile patients have an unusual presentation that frequently misleads severity assessment and results in poor clinical outcome. The aim of this study was to evaluate the role of proadrenomedullin (proADM) in predicting disease severity and outcome in HCAP patients in comparison with community-acquired pneumonia (CAP) patients. Patients and methods Thirty-one HCAP patients and twenty-five CAP patients were enrolled in this study. Measurement of serum proADM level was performed in the first 24-h of admission. Assessment of severity was carried out using the CURB-65 scoring system. Finally, the outcome of the patients was assessed. Results Serum proADM level was higher in HCAP patients than that in CAP patients, this difference was statistically significant. Also, serum proADM level increased significantly with increasing severity of HCAP patients guided by CURB-65, with a cut-off value of more than 1.8 nmol/l, with a sensitivity of 91.7%, a specificity of 95%, a positive predictive value of 91.7%, and a negative predictive value of 95%. However, a higher value (>2.9 nmol/l) was detected in HCAP patients who died, with high sensitivity and negative predictive value (100%) and low specificity (42.3%) and positive predictive value (25%). Conclusion The use of proADM as a novel biomarker enhances the performance of the CURB-65 scoring system for risk stratification of HCAP patients.

Highlights

Pneumonias have been classified as communityacquired pneumonia (CAP) and hospital-acquired pneumonia, and this classification is used for proper diagnosis and treatment decisions [1]
Serum proADM level increased significantly with increasing severity of healthcare-associated pneumonia (HCAP) patients guided by CURB-65, with a cut-off value of more than 1.8 nmol/l, with a sensitivity of 91.7%, a specificity of 95%, a positive predictive value of 91.7%, and a negative predictive value of 95%
A serum proADM level more than 1.8 nmol/l had good sensitivity and positive predictive value (PPV) (91.7% for each), and high specificity and negative predictive value (NPV) (95% for each) in predicting severe disease among HCAP

Summary

Introduction

Pneumonias have been classified as communityacquired pneumonia (CAP) and hospital-acquired pneumonia, and this classification is used for proper diagnosis and treatment decisions [1]. Clinical judgment of HCAP represents a major concern as these fragile patients have an unusual clinical presentation that frequently misleads severity assessment and results in poor clinical outcome [4]. Several generic severity scoring systems have been developed to determine patients’ outcome, but they may be complicated for use in everyday practice [6]. These scores may underestimate severity assessment in young patients and perform less well when considering outcomes such as ICU admission and mechanical ventilation (MV) [7]. Clinical judgment of healthcare-associated pneumonia (HCAP) represents a major concern as these fragile patients have an unusual presentation that frequently misleads severity assessment and results in poor clinical outcome. The aim of this study was to evaluate the role of proadrenomedullin (proADM) in predicting disease severity and outcome in HCAP patients in comparison with community-acquired pneumonia (CAP) patients

Objectives

Methods

Results

Discussion

Conclusion