Effectiveness of Proadrenomedullin Enhanced CURB65 Score Algorithm in Patients with Community-Acquired Pneumonia in "Real Life", an Observational Quality Control Survey.
Effectiveness of Proadrenomedullin Enhanced CURB65 Score Algorithm in Patients with Community-Acquired Pneumonia in "Real Life", an Observational Quality Control Survey.
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DOI：
10.3390/jcm3010267
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发表时间：
2014-03-14
影响因子：
3.9
通讯作者：
Albrich WC
中科院分区：
文献类型：
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作者：
Widmer D;Drozdov D;Rüegger K;Litke A;Arici B;Regez K;Guglielmetti M;Schild U;Conca A;Schäfer P;Kouegbe RB;Reutlinger B;Blum C;Schuetz P;Irani S;Huber A;Bürgi U;Müller B;Albrich WC
背景资料：一项干预试验发现，当CURB 65评分与预后生物标志物肾上腺髓质素原（ProADM）（CURB 65-A）相结合时，社区获得性肺炎（CAP）患者的住院时间（LOS）有缩短的趋势。然而，CURB 65-A在真实的生活中的有效性和安全性仍不清楚。研究方法：从2011年9月至2012年4月，我们在瑞士Aarau州立医院对连续的CAP成人进行了一项研究后前瞻性观察性质量控制调查。主要终点是住院期间和30天内的住院时间（LOS）。我们使用多变量回归将结果与在同一医院住院的两个明确定义的CAP患者历史队列进行比较，即未使用ProADM的观察研究（OPTIMA I）中的83例患者和干预研究（OPTIMA II RCT）中的169例患者。结果：共纳入89例确诊为CAP的患者。与仅在OPTIMA I研究中观察到的CURB 65患者相比，校正回归分析显示，当在临床常规中使用CURB 65-A时，初始LOS显著缩短（7.5 vs. 10.4天; −2.32; 95% CI，−4.51至−0.13; p = 0.04）。30天内LOS无显著差异。队列之间在死亡率和ICU入院方面的安全性结局无显著差异。结论：这项研究后调查提供的证据表明，在“真实的生活”情况下，与单独使用CURB 65评分相比，ProADM联合CURB 65（CURB 65-A）可降低初始LOS，对患者安全性无明显负面影响。
Background: An intervention trial found a trend for shorter length of stay (LOS) in patients with community-acquired pneumonia (CAP) when the CURB65 score was combined with the prognostic biomarker proadrenomedullin (ProADM) (CURB65-A). However, the efficacy and safety of CURB65-A in real life situations remains unclear. Methods: From September, 2011, until April, 2012, we performed a post-study prospective observational quality control survey at the cantonal Hospital of Aarau, Switzerland of consecutive adults with CAP. The primary endpoint was length of stay (LOS) during the index hospitalization and within 30 days. We compared the results with two well-defined historic cohorts of CAP patients hospitalized in the same hospital with the use of multivariate regression, namely 83 patients in the observation study without ProADM (OPTIMA I) and the 169 patients in the intervention study (OPTIMA II RCT). Results: A total of 89 patients with confirmed CAP were included. As compared to patients with CURB65 only observed in the OPTIMA I study, adjusted regression analysis showed a significant shorter initial LOS (7.5 vs. 10.4 days; −2.32; 95% CI, −4.51 to −0.13; p = 0.04) when CURB65-A was used in clinical routine. No significant differences were found for LOS within 30 days. There were no significant differences in safety outcomes in regard to mortality and ICU admission between the cohorts. Conclusion: This post-study survey provides evidence that the use of ProADM in combination with CURB65 (CURB65-A) in “real life” situations reduces initial LOS compared to the CURB65 score alone without apparent negative effects on patient safety.