- 作者：Agustí ; n Juliá ; n-Jimé ; nez<sup>asup><sup> ; sup><sup>agustinj@sescam.jccm.es" class="auth_mailsup><sup> ; sup><sup>agustin.jj@wanadoo.es" class="auth_mailsup> ; Jesú ; s Timó ; n Zapata<sup>bsup> ; Emilio José ; Laserna Mendieta<sup>bsup> ; Isabel Sicilia-Bravo<sup>bsup> ; Marí ; a José ; Palomo-de los Reyes<sup>asup> ; Á ; ngeles Cabezas-Martí ; nez<sup>bsup> ; Natividad Laí ; n-Teré ; s<sup>asup> ; Josefa Estebaran-Martí ; n<sup>asup> ; Agustí ; n Lozano-Ancí ; n<sup>asup> ; Rafael Cuena-Boy<sup>csup>
- 关键词：Neumoní ; a adquirida en la comunidad ; Pneumonia Severity Index ; Mortalidad ; Urgencias ; Biomarcadores ; Bacteriemia ; Procalcitonina ; Proteí ; na C reactiva ; Proadrenomedulina ; Lactato
- 刊名：Enfermedades Infecciosas y Microbiolog铆a Cl铆nica
- 出版年：April, 2014
- 年：2014
- 卷：32
- 期：4
- 页码：225-235
- 全文大小：806 K
ss="h4">Objectives
To analyse the usefulness and performance of several biomarkers [C-reactive protein (CRP), mid-regional pro-adrenomedullin (MR-proADM), procalcitonin (PCT)] and lactate in predicting short- and medium-term mortality compared with the prognostic severity scales (PSS) usually employed for community-acquired pneumonia (CAP) and in assessing the aetiological suspicion of infection by Streptococcus pneumoniae and bacteraemia.
ss="h4">Methods
Observational, prospective and analytical study was conducted on patients who were diagnosed with CAP in our emergency department (ED). The data collected included socio-demographic and comorbidity variables, Charlson index, priority level according to the Spanish Triage System (STS), stage in the Pneumonia Severity Index (PSI) and in the CURB-65 (confusion, urea, respiratory rate, blood pressure and age 鈮?#xA0;65 years), criteria of severe CAP, microbiological studies, and biomarkers determinations. The patients were followed-up for 180 days to calculate the prognostic power and the diagnostic performance for bacteraemia and aetiology.
ss="h4">Results
A total of 127 patients were finally enrolled in the study. The 30-day mortality was 10.3% (13), and 22.6% (28) at 180 days. Blood cultures were positive in 29 patients (23%) and S. pneumoniae was identified as the responsible pathogen in 28 cases (22.2%). The area under the ROC curve (AUC-ROC) for lactate and MR-proADM to predict 30-day mortality was 0.898 (95% CI: 0.824-0.973; P < .0001) and 0.892 (95% CI: 0.811-0.974; P < .0001), respectively, and for MR-proADM at 180 days it was 0.921 (95% CI: 0.874-0.968; P < .0001). The AUC-ROC for PCT to predict bacteraemia was 0.952 (95% CI: 0.898-1.000; P < .0001) and, considering a cut-off value 鈮?#xA0;0.95 ng/ml, the negative predictive value (NPV) and the likelihood ratio (LR+) were 97.8% and 9.03, respectively. Using a PCT cut-off value > 0.85 ng/ml, the NPV and the LR+ were 96.6% and 5.89%, respectively, to predict a S. pneumoniae infection.
ss="h4">Conclusions
MR-proADM and lactate showed a similar or even better performance for 30-day intra-hospital mortality than PSI, CURB-65, STS and CAP severity criteria in patients diagnosed with CAP (P > .05). Furthermore, the MR-proADM capacity to predict 180-day mortality was higher than PSS and the rest of biomarkers (P > .05), and its AUC-ROC increased if it was used in combination with PSI, CURB65 and STS. The determination of PCT has a remarkable diagnostic performance to rule out bacteraemia and to orientate the aetiology towards a S. pneumoniae infection.