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Role of some biomarkers in determining the risk of mortality of hospitalized patients with community- acquired pneumonia

Darina Miteva, Yordan Radkov, Lilyia Ivanova, Vanya Kostadinova, Trifon Chervenkov

Abstract

Introduction: Various biomarkers are used to determine the severity and risk of mortality in community-acquired pneumonia (CAP). The aim of this article is to evaluate the prognostic value for in-hospital mortality of leukocyte count (Leuk), C-reactive protein (CRP), procalcitonin (PCT), and mid-regional proadrenomedullin (MR-proADM) in CAP patients.

Materials and Methods: This was a prospective study including a total of 92 CAP patients hospitalized in the Clinic of Pneumology and Phthisiatry at St. Marina University Hospital of Varna. Biomarkers were determined at hospitalization, Leuk - by automated methodology, CRP - by latex-enhanced immuno-turbidimetric method, and both MR-proADM and PCT - by standard ELISA. CAP severity was estimated by Pneumonia Severity Index (PSI) and CURB-65.

Results: The patients were at a mean age of 59.2±16.8 years, 68.5% were men. In-hospital mortality was 7.6%. The optimal cut-off value of MR-proADM for in-hospital mortality was 0.88 ng/mL (sensitivity 85.7% and specificity 85.8%). The positive predictive value was 33.3% and the negative predictive value was 98.6%. The optimal cut-off value of PCT was 1.84 ng/mL (sensitivity 71.4% and specificity 81.1%). The positive predictive value was 23.8% and the negative predictive value was 97.1%. Cut-off values for CRP and Leuk could not be established. By performing ROC curves, MR-proADM, PSI, PCT and CURB-65 were good predictors for in-hospital mortality (AUC 0.91, 0.90, 0.89, and 0.86, respectively).

Conclusion: MR-proADM and PCT are promising markers in predicting CAP prognosis. Their predictive value for mortality is similar to that of PSI and CURB-65. CRP and Leuk cannot serve as predictors.


Keywords

CAP, MR-proADM, PCT, CRP, mortality

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References

Engel MF, Paling FP, Hoepelman AI, van der Meer V, Oosterheert JJ. Evaluating the evidence for the implementation of C-reactive protein measurement in adult patients with suspected lower respiratory tract infection in primary care: a systematic review. Fam Pract. 2012;29(4):383-93. doi: 10.1093/fampra/cmr119.

Thiem U, Niklaus D, Sehlhoff B, Stückle C, Heppner HJ, Endres HG, et al. C-reactive protein, severity of pneumonia and mortality in elderly, hospitalized patients with community-acquired pneumonia. Age Ageing. 2009;38(6):693-7. doi: 10.1093/ageing/afp164.

Christ-Crain M, Jaccard-Stolz D, Bingisser R, Gencay M, Huber P, Tamm M, et al. Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections: cluster-randomised, single-blinded intervention trial. Lancet. 2004;363(9409):600-7. doi: 10.1016/S0140-6736(04)15591-8.

Christ-Crain M, Stolz D, Bingisser R, Müller C, Miedinger D, Huber PR, et al. Procalcitonin guidance of antibiotic therapy in community-acquired pneumonia: a randomized trial. Am J Respir Crit Care Med. 2006;174(1):84-93. doi: 10.1164/rccm.200512-1922OC.

Schuetz P, Christ-Crain M, Thomann R, Falconnier C, Wolbers M, Widmer I, et al. Effect of procalcitonin-based guidelines vs standard guidelines on antibiotic use in lower respiratory tract infections: the ProHOSP randomized controlled trial. JAMA. 2009;302(10):1059-66. doi: 10.1001/jama.2009.1297.

Christ-Crain M, Muller B. Procalcitonin in bacterial infections - hype, hope, more or less? Swiss Med Wkly.2005;135(31-32):451-60. doi: 2005/31/smw-11169.

Ueda S, Nishio K, Minamino N, Kubo A, Akai Y, Kangawa K, et al. Increased plasma levels of adrenomedullin in patients with systemic inflammatory response syndrome. Am J Respir Crit Care Med. 1999;160(1):132-6. doi:10.1164/ajrccm.160.1.9810006.

Bello S, Lasierra AB, Minchole E, Fandos S, Ruiz MA, Vera E, et al. Prognostic power of proadrenomedullin in community-acquired pneumonia is independent on etiology. Eur Respir J. 2012;39(5):1144-55. doi: 10.1183/09031936.00080411.

Huang DT, Angus DC, Kellum JA, Pugh NA, Weissfeld LA, Struck J, et al. Midregional proadrenomedullin as a prognostic tool in community-acquired pneumonia. Chest. 2009;136(3):823-31. doi:10.1378/chest.08-1981.

Suberviola B, Castellanos-Ortega A, Llorca J, Ortiz F, Iglesias D, Prieto B. Prognostic value of proadrenomedullin in severe sepsis and septic shock patients with community-acquired pneumonia. Swiss Med Wkly. 2012;142:w13542. doi: 10.4414/smw.2012.13542.

Albrich WC, Dusemund F, Rüegger K, Christ-Crain M, Zimmerli W, Bregenzer T, et al. Enhancement of CURB65 score with proadrenomedullin (CURB65-A) for outcome prediction in lower respiratory tract infections: derivation of a clinical algorithm. BMC Infect Dis. 2011;11:112. doi: 10.1186/1471-2334-11-112.

British Thoracic Society Standards of Care Committee. BTS Guidelines for the Management of Community Acquired Pneumonia in Adults. Thorax 2001;56 Suppl 4:IV1-64. doi: 10.1136/thorax.56.suppl_4.iv1.

Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997;336(4):243-50. doi: 10.1056/NEJM199701233360402.

Chalmers JA, Singanayagam A, Hill AT. C-reactive protein is an independent predictor of severity in community-acquired pneumonia. Am J Med. 2008;121(3):219-25. doi: 10.1016/j.amjmed.2007.10.033

Lee JH, Kim J, Kim K, Jo YH, Rhee J, Kim TY, et al. Albumin and C-reactive protein have prognostic significance in patients with community-acquired pneumonia. J Crit Care. 2011;26 (3):287-94. doi:1016/j.jcrc.2010.10.007.

Christ-Crain M, Morgenthaler NG, Stolz D, Müller C, Bingisser R, Harbarth S, et al. Pro-adrenomedullin to predict severity and outcome in community-acquired pneumonia [ISRCTN04176397]. Crit. Care. 2006;10(3):R96-103. doi:10.1186/cc4955.

Boussekey N, Leroy O, Georges H, Devos P, d`Escrivan T, Guery B. Diagnostic and prognostic values of admission procalcitonin levels in community-acquired pneumonia in an intensive care unit. Infection. 2005;33(4):257-63. doi:10.1007/s15010-005-4096-2.

Krüger S, Ewig S, Kunde J, Hartmann O, Marre R, Suttorp N, et al. Assessment of inflammatory markers in patients with community-acquired pneumonia - influence of antimicrobial pre-treatment. Results from the German competence network CAPNETZ. Clin Chim Acta. 2010;411(23-24):1929-34. doi: 10.1016/j.cca.2010.08.004.

Park JH, Wee JH, Choi SP, Oh SH. The value of procalcitonin level in community-acquired pneumonia in the ED. Am J Emerg Med. 2012;30(7):1248-54. doi: 10.1016/j.ajem.2011.08.009.

McCluskey SM, Schuetz P, Abers MS, Bearnot B, Morales ME, Hoffman D, et al. Serial procalcitonin as a predictor of bacteremia and need for intensive care unit care in adults with pneumonia, including those with highest severity: a prospective cohort study. Open Forum Infect Dis. 2017;4(1):ofw238. doi: 10.1093/ofid/ofw238.

Liu D, Su LX, Guan W, Xiao K, Xie LX. Prognostic value of procalcitonin in pneumonia: A systematic review and meta-analysis. Respirology. 2016;21(2):280-8. doi: 10.1111/resp.12704.

Julián-Jiménez A, Timón Zapata J, Laserna Mendieta EJ, Sicilia-Bravo I, Palomo-de Los Reyes MJ, Cabezas-Martínez A, et al. Diagnostic and prognostic power of biomarkers to improve the management of community acquired pneumonia in the emergency department. Enferm Infecc Microbiol Clin. 2014;32(4):225-35 (in Spanish). doi: 10.1016/j.eimc.2013.04.015.

Schuetz P, Wolbers M, Christ-Crain M, Thomann R, Falkonnier C, Widmer I, et al. Prohormones for prediction of adverse medical outcome in community-acquired pneumonia and lower respiratory tract infections. Crit Care. 2010;14(3):R106. doi: 10.1186/cc9055.

Schuetz P, Suter-Widmer I, Chaudri A, Christ-Crain M, Zimmerli W, Mueller B. Prognostic value of procalcitonin in community-acquired pneumonia. Eur Respir J. 2011;37(2):384-92. doi: 10.1183/09031936.00035610.

Haeuptle J, Zaborsky R, Fiumefreddo R, Trampuz A, Steffen I, Frei R, et al. Prognostic value of procalcitonin in Legionella pneumonia. Eur J Clin Microbiol Infect Dis. 2009;281(1):55-60. doi: 10.1007/s10096-008-0592-5.

Kutz A, Briel B, Christ-Crain M, Stolz D, Bouadma L, Wolff M, et al. Prognostic value of procalcitonin in respiratory tract infections across clinical settings. Crit Care. 2015;19(1):74. doi: 10.1186/s13054-015-0792-1.

Krüger S, Ewig S, Marre R, Papassotiriou J, Richter K, von Baum H, et al. Procalcitonin predicts patients at low risk of death from community-acquired pneumonia. Eur Respir J. 2008;31(2):349-55. doi: 10.1183/09031936.00054507.




DOI: http://dx.doi.org/10.14748/ssm.v49i4.4023

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About The Authors

Darina Miteva
Medical University of Varna
Bulgaria

Department of Pulmonology and Allergology

Yordan Radkov
Medical University of Varna
Bulgaria

Department of Pulmonology and Allergology

Lilyia Ivanova
Medical University of Varna
Bulgaria

Department of Microbiology and Virology

Vanya Kostadinova
Medical University of Varna
Bulgaria

Department of Pulmonology and Allergology

Trifon Chervenkov
Medical University of Varna
Bulgaria

Department of Medical Genetics

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