Mid-regional pro-adrenomedullin and copeptin to predict short-term prognosis of COPD exacerbations: a multicenter prospective blinded study.
Mid-regional pro-adrenomedullin and copeptin to predict short-term prognosis of COPD exacerbations: a multicenter prospective blinded study.
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DOI：
10.2147/copd.s126400
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发表时间：
2017
影响因子：
2.8
通讯作者：
Roche N
中科院分区：
文献类型：
--
作者：
Dres M;Hausfater P;Foissac F;Bernard M;Joly LM;Sebbane M;Philippon AL;Gil-Jardiné C;Schmidt J;Maignan M;Treluyer JM;Roche N
慢性阻塞性肺疾病(ECOPD)的恶化是急诊室就诊的常见原因。早期结果的预测指标可以帮助临床医生做出定位决定。在目前的研究中，我们调查了中期前肾上腺髓质素(MR-proADM)和Copeptin，除了临床评估外，是否可以预测短期结果。这项前瞻性盲法观察研究是在20个法国中心进行的。急诊室接受ECOPD的患者被考虑纳入。计算临床风险评分，并从静脉血样本中测定MR-proADM和Copeptin水平。综合主要终点包括30天死亡或转到重症监护病房或新的急诊室就诊。共有379名患者参加了这项研究，其中277名患者最终被调查了发生在66名患者(24%)中的主要终点。在这些患者中，MR-proADM水平的中位数(四分位数范围)为1.02nmol/L(0.77~1.48)，而未达到主要终点的患者为0.83nmol/L(0.63~1.07)(P=0.0009)。相反，在达到或没有达到主要终点的患者中，铜绿素水平相似(P=0.23)。MR-proADM水平随临床危险评分的升高而升高，低、中、高三类的MR-proADM水平分别为0.74nmol/L(0.57~0.89)、0.83nmol/L(0.62~1.12)和0.95nmol/L(0.75~1.29)(P<；0.001)。MR-proADM与主要终点独立相关(优势比为1.65；95%可信区间为1.10-2.48；P=0.015)。MR-proADM预测主要终点的敏感性为46%(95%CI，33%-58%)，特异性为79%(95%CI，74-84)。MR-proADM而不是Copeptin与30天后的结果显著相关，即使在调整了临床风险类别后也是如此。总体而言，MR-proADM单独或与临床风险评分相结合，是短期结果的中强预测因子。
Exacerbations of COPD (ECOPD) are a frequent cause of emergency room (ER) visits. Predictors of early outcome could help clinicians in orientation decisions. In the current study, we investigated whether mid-regional pro-adrenomedullin (MR-proADM) and copeptin, in addition to clinical evaluation, could predict short-term outcomes. This prospective blinded observational study was conducted in 20 French centers. Patients admitted to the ER for an ECOPD were considered for inclusion. A clinical risk score was calculated, and MR-proADM and copeptin levels were determined from a venous blood sample. The composite primary end point comprised 30-day death or transfer to the intensive care unit or a new ER visit. A total of 379 patients were enrolled in the study, of whom 277 were eventually investigated for the primary end point that occurred in 66 (24%) patients. In those patients, the median (interquartile range [IQR]) MR-proADM level was 1.02 nmol/L (0.77–1.48) versus 0.83 nmol/L (0.63–1.07) in patients who did not meet the primary end point (P=0.0009). In contrast, copeptin levels were similar in patients who met or did not meet the primary end point (P=0.23). MR-proADM levels increased with increasing clinical risk score category: 0.74 nmol/L (0.57–0.89), 0.83 nmol/L (0.62–1.12) and 0.95 nmol/L (0.75–1.29) for the low-, intermediate- and high-risk categories, respectively (P<0.001). MR-proADM was independently associated with the primary end point (odds ratio, 1.65; 95% confidence interval [CI], 1.10–2.48; P=0.015). MR-proADM predicted the occurrence of primary end point with a sensitivity of 46% (95% CI, 33%–58%) and a specificity of 79% (95% CI, 74–84). MR-proADM but not copeptin was significantly associated with outcomes at 30 days, even after adjustment for clinical risk category. Overall, MR-proADM, alone or combined with the clinical risk score, was a moderate strong predictor of short-term outcomes.