Utility of Procalcitonin (PCT) and Mid regional pro-Adrenomedullin (MR-proADM) in risk stratification of critically ill febrile patients in Emergency Department (ED). A comparison with APACHE II score
Utility of Procalcitonin (PCT) and Mid regional pro-Adrenomedullin (MR-proADM) in risk stratification of critically ill febrile patients in Emergency Department (ED). A comparison with APACHE II score
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DOI：
10.1186/1471-2334-12-184
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发表时间：
2012-08-08
影响因子：
3.7
通讯作者：
Di Somma, Salvatore
中科院分区：
文献类型：
--
作者：
Travaglino, Francesco;De Berardinis, Benedetta;Di Somma, Salvatore
背景：我们研究的目的是评估MR-proADM和PCT水平在急诊科发热患者中的预后价值，并与疾病严重程度指数评分APACHE II评分进行比较。我们还评估了MR-proADM和PCT预测住院的能力。方法：这是一项观察性多中心研究。我们招募了128例到急诊科就诊的高热患者，并怀疑有严重感染，如败血症、下呼吸道感染、尿路感染、胃肠道感染、软组织感染、中枢神经系统感染或骨髓炎。计算每位患者的APACHE II评分。结果：对照组MR-proADM中位数为0.5 nmol/l，而患者为0.85 nmol/l (P < 0.0001)；对照组PCT中位数为0.06 ng/ml，而患者为0.56 ng/ml （P < 0.0001）。在所有患者中，根据PCT值MR-proADM水平均有统计学意义的逐步升高（P < 0.0001）。MR-proADM和PCT水平根据Apache II四分位数显著升高（P < 0.0001和P = 0.0012）。在呼吸道感染、泌尿系统感染和脓毒症-脓毒症休克组中，我们发现Apache II分别与MR-proADM和MR-proADM与PCT之间存在相关性。我们评估了MR-proADM和PCT对急诊科以发热为主诉的患者住院的预测能力。单独MR-proADM的AUC为0.694，单独PCT的AUC为0.763。PCT与MR-proADM联合使用的AUC为0.79。结论：本研究强调MR-proADM和PCT可能有助于急诊科发热患者的护理。我们的数据支持MR-proADM和PCT在这种情况下的预后作用，正如与APACHE II评分的相关性所证明的那样。两种生物标志物的联合使用可以预测发热患者随后的住院治疗。合理使用这两种分子可以带来一些优势，例如更快的诊断，更准确的风险分层和优化治疗，从而使患者受益并大大降低成本。
Background: 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. We also evaluated the ability of MR-proADM and PCT to predict hospitalization.Methods: This 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.Results: MR-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.Conclusions: 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. 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.