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Enhancement of CURB65 score with proadrenomedullin (CURB65-A) for outcome prediction in lower respiratory tract infections: derivation of a clinical algorithm.

Albrich WC, Dusemund F, Rüegger K, Christ-Crain M, Zimmerli W, Bregenzer T, Irani S, Buergi U, Reutlinger B, Mueller B, Schuetz P - BMC Infect. Dis. (2011)

Bottom Line: Within each CURB65 class, higher ProADM-levels were associated with an increased risk of adverse events and mortality.The new CURB65-A risk score combining CURB65 risk classes with ProADM cut-off values accurately predicts adverse events and mortality in patients with CAP and non-CAP-LRTI.Additional prospective cohort or intervention studies need to validate this score and demonstrate its safety and efficacy for the management of patients with LRTI.

View Article: PubMed Central - HTML - PubMed

Affiliation: Medical University Department of the University of Basel, Kantonsspital Aarau, Switzerland.

ABSTRACT

Background: Proadrenomedullin (ProADM) confers additional prognostic information to established clinical risk scores in lower respiratory tract infections (LRTI). We aimed to derive a practical algorithm combining the CURB65 score with ProADM-levels in patients with community-acquired pneumonia (CAP) and non-CAP-LRTI.

Methods: We used data of 1359 patients with LRTI enrolled in a multicenter study. We chose two ProADM cut-off values by assessing the association between ProADM levels and the risk of adverse events and mortality. A composite score (CURB65-A) was created combining CURB65 classes with ProADM cut-offs to further risk-stratify patients.

Results: CURB65 and ProADM predicted both adverse events and mortality similarly well in CAP and non-CAP-LRTI. The combined CURB65-A risk score provided better prediction of death and adverse events than the CURB65 score in the entire cohort and in CAP and non-CAP-LRTI patients. Within each CURB65 class, higher ProADM-levels were associated with an increased risk of adverse events and mortality. Overall, risk of adverse events (3.9%) and mortality (0.65%) was low for patients with CURB65 score 0-1 and ProADM ≤0.75 nmol/l (CURB65-A risk class I); intermediate (8.6% and 2.6%, respectively) for patients with CURB65 score of 2 and ProADM ≤1.5 nmol/l or CURB classes 0-1 and ProADM levels between 0.75-1.5 nmol/L (CURB65-A risk class II), and high (21.6% and 9.8%, respectively) for all other patients (CURB65-A risk class III). If outpatient treatment was recommended for CURB65-A risk class I and short hospitalization for CURB65-A risk class II, 17.9% and 40.8% of 1217 hospitalized patients could have received ambulatory treatment or a short hospitalization, respectively.

Conclusions: The new CURB65-A risk score combining CURB65 risk classes with ProADM cut-off values accurately predicts adverse events and mortality in patients with CAP and non-CAP-LRTI. Additional prospective cohort or intervention studies need to validate this score and demonstrate its safety and efficacy for the management of patients with LRTI.

Trial registration: Procalcitonin-guided antibiotic therapy and hospitalisation in patients with lower respiratory tract infections: the prohosp study; isrctn.org Identifier: ISRCTN: ISRCTN95122877.

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Related in: MedlinePlus

Risk classification stratified for outpatients (A) and inpatients (B). Risk classification stratified for outpatients (A) and inpatients (B) according to CURB65-A. Risk class I = green, risk class II = orange, risk class III = red.
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Figure 6: Risk classification stratified for outpatients (A) and inpatients (B). Risk classification stratified for outpatients (A) and inpatients (B) according to CURB65-A. Risk class I = green, risk class II = orange, risk class III = red.

Mentions: We further assessed potential impact of this new risk score on in- and outpatient treatment. Of 142 patients who were treated as outpatients, ambulatory treatment would indeed be recommended for 88 (62.0%; risk class I), whereas in 38 (26.8%) short hospitalization (risk class II) and in 16 (11.3%) hospitalization (risk class III) would be recommended based on CURB65-A (Figure 6). Conversely, in 218 (17.8%) and 496 (40.8%) of the 1217 hospitalized patients, outpatient treatment or a short hospitalization would be recommended according to CURB65-A risk.


Enhancement of CURB65 score with proadrenomedullin (CURB65-A) for outcome prediction in lower respiratory tract infections: derivation of a clinical algorithm.

Albrich WC, Dusemund F, Rüegger K, Christ-Crain M, Zimmerli W, Bregenzer T, Irani S, Buergi U, Reutlinger B, Mueller B, Schuetz P - BMC Infect. Dis. (2011)

Risk classification stratified for outpatients (A) and inpatients (B). Risk classification stratified for outpatients (A) and inpatients (B) according to CURB65-A. Risk class I = green, risk class II = orange, risk class III = red.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3119069&req=5

Figure 6: Risk classification stratified for outpatients (A) and inpatients (B). Risk classification stratified for outpatients (A) and inpatients (B) according to CURB65-A. Risk class I = green, risk class II = orange, risk class III = red.
Mentions: We further assessed potential impact of this new risk score on in- and outpatient treatment. Of 142 patients who were treated as outpatients, ambulatory treatment would indeed be recommended for 88 (62.0%; risk class I), whereas in 38 (26.8%) short hospitalization (risk class II) and in 16 (11.3%) hospitalization (risk class III) would be recommended based on CURB65-A (Figure 6). Conversely, in 218 (17.8%) and 496 (40.8%) of the 1217 hospitalized patients, outpatient treatment or a short hospitalization would be recommended according to CURB65-A risk.

Bottom Line: Within each CURB65 class, higher ProADM-levels were associated with an increased risk of adverse events and mortality.The new CURB65-A risk score combining CURB65 risk classes with ProADM cut-off values accurately predicts adverse events and mortality in patients with CAP and non-CAP-LRTI.Additional prospective cohort or intervention studies need to validate this score and demonstrate its safety and efficacy for the management of patients with LRTI.

View Article: PubMed Central - HTML - PubMed

Affiliation: Medical University Department of the University of Basel, Kantonsspital Aarau, Switzerland.

ABSTRACT

Background: Proadrenomedullin (ProADM) confers additional prognostic information to established clinical risk scores in lower respiratory tract infections (LRTI). We aimed to derive a practical algorithm combining the CURB65 score with ProADM-levels in patients with community-acquired pneumonia (CAP) and non-CAP-LRTI.

Methods: We used data of 1359 patients with LRTI enrolled in a multicenter study. We chose two ProADM cut-off values by assessing the association between ProADM levels and the risk of adverse events and mortality. A composite score (CURB65-A) was created combining CURB65 classes with ProADM cut-offs to further risk-stratify patients.

Results: CURB65 and ProADM predicted both adverse events and mortality similarly well in CAP and non-CAP-LRTI. The combined CURB65-A risk score provided better prediction of death and adverse events than the CURB65 score in the entire cohort and in CAP and non-CAP-LRTI patients. Within each CURB65 class, higher ProADM-levels were associated with an increased risk of adverse events and mortality. Overall, risk of adverse events (3.9%) and mortality (0.65%) was low for patients with CURB65 score 0-1 and ProADM ≤0.75 nmol/l (CURB65-A risk class I); intermediate (8.6% and 2.6%, respectively) for patients with CURB65 score of 2 and ProADM ≤1.5 nmol/l or CURB classes 0-1 and ProADM levels between 0.75-1.5 nmol/L (CURB65-A risk class II), and high (21.6% and 9.8%, respectively) for all other patients (CURB65-A risk class III). If outpatient treatment was recommended for CURB65-A risk class I and short hospitalization for CURB65-A risk class II, 17.9% and 40.8% of 1217 hospitalized patients could have received ambulatory treatment or a short hospitalization, respectively.

Conclusions: The new CURB65-A risk score combining CURB65 risk classes with ProADM cut-off values accurately predicts adverse events and mortality in patients with CAP and non-CAP-LRTI. Additional prospective cohort or intervention studies need to validate this score and demonstrate its safety and efficacy for the management of patients with LRTI.

Trial registration: Procalcitonin-guided antibiotic therapy and hospitalisation in patients with lower respiratory tract infections: the prohosp study; isrctn.org Identifier: ISRCTN: ISRCTN95122877.

Show MeSH
Related in: MedlinePlus