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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


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.


CAP, MR-proADM, PCT, CRP, mortality

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About The Authors

Darina Miteva
Medical University of Varna

Department of Pulmonology and Allergology

Yordan Radkov
Medical University of Varna

Department of Pulmonology and Allergology

Lilyia Ivanova
Medical University of Varna

Department of Microbiology and Virology

Vanya Kostadinova
Medical University of Varna

Department of Pulmonology and Allergology

Trifon Chervenkov
Medical University of Varna

Department of Medical Genetics

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