Abstract
BackgroundThe aim of our study was to evaluate the prognostic value of MR-proADM and PCT levels in febrile patients in the ED in comparison with a disease severity index score, the APACHE II score. We also evaluated the ability of MR-proADM and PCT to predict hospitalization.MethodsThis was an observational, multicentric study. We enrolled 128 patients referred to the ED with high fever and a suspicion of severe infection such as sepsis, lower respiratory tract infections, urinary tract infections, gastrointestinal infections, soft tissue infections, central nervous system infections, or osteomyelitis. The APACHE II score was calculated for each patient.ResultsMR-proADM median values in controls were 0.5 nmol/l as compared with 0.85 nmol/l in patients (P < 0.0001), while PCT values in controls were 0.06 ng/ml versus 0.56 ng/ml in patients (P < 0.0001). In all patients there was a statistically significant stepwise increase in MR-proADM levels in accordance with PCT values (P < 0.0001). MR-proADM and PCT levels were significantly increased in accordance with the Apache II quartiles (P < 0.0001 and P = 0.0012 respectively).In the respiratory infections, urinary infections, and sepsis-septic shock groups we found a correlation between the Apache II and MR-proADM respectively and MR-proADM and PCT respectively. We evaluated the ability of MR-proADM and PCT to predict hospitalization in patients admitted to our emergency departments complaining of fever. MR-proADM alone had an AUC of 0.694, while PCT alone had an AUC of 0.763. The combined use of PCT and MR-proADM instead showed an AUC of 0.79.ConclusionsThe present study highlights the way in which MR-proADM and PCT may be helpful to the febrile patient’s care in the ED. Our data support the prognostic role of MR-proADM and PCT in that setting, as demonstrated by the correlation with the APACHE II score. The combined use of the two biomarkers can predict a subsequent hospitalization of febrile patients. The rational use of these two molecules could lead to several advantages, such as faster diagnosis, more accurate risk stratification, and optimization of the treatment, with consequent benefit to the patient and considerably reduced costs.
Highlights
The aim of our study was to evaluate the prognostic value of MR-proADM and PCT levels in febrile patients in the Emergency Department (ED) in comparison with a disease severity index score, the APACHE II score
The present study highlights the way in which MR-proADM and PCT may be helpful to the febrile patient’s care in the ED
Our data support the prognostic role of MR-proADM and PCT in that setting, as demonstrated by the correlation with the APACHE II score
Summary
The aim of our study was to evaluate the prognostic value of MR-proADM and PCT levels in febrile patients in the ED in comparison with a disease severity index score, the APACHE II score. Accurate identification of fever aetiology in patients presenting to the ED is a desirable objective, but often it is unattainable, largely because signs and symptoms of bacterial and viral infections considerably overlap each other and often are nonspecific This leads to a delay in establishing a fast aetiological diagnosis in the ED and to an inappropriate use of antibiotics [2]. Medical literature has demonstrated that in critically ill patients with sepsis, PCT is superior to CRP in diagnosing bacterial infections [6,7]. Another molecule studied in febrile and septic patients is Adrenomedullin (ADM), a 52 amino acids peptide with immune modulating, metabolic, and vasodilator activity. The Mid Regional fragment of pro–Adrenomedullin (MR-proADM), included between amino acids 45-92, is the more stable part of the ADM, and it has been detected in plasma of patients with septic shock as a consequence of the ADM active peptide degradation [9]
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