Three pneumonia severity index in emergency department patients with community acquired pneumonia and association between proadrenomedullin and mortality

BACKGROUND: Community-acquired pneumonia (CAP) is one of the most common infectious diseases presented in emergency departments (EDs). Treatment failure in CAP patients is associated with high morbidity and mortality rates. Several rules and guidelines therefore have been developed to predict mortality, safe management in the outpatient setting, and hospitalization or intensive care unit (ICU) admission of patients with CAP. For this purpose, in recent years, particularly new biomarkers have been studied and one of the most important is proadrenomedullin (Pro-ADM). OBJECTIVE: The aim of this study is to compare the prognostic value of these three predictive rules; Pneumonia severity index (PSI), CURB65 (confusion, urea level, respiratory rate, blood pressure, <65 years of age), SOAR (systolic blood pressure, oxygenation, age, respiratory rate) and Pro-ADM levels at predicting hospitalization, admission to ICU and mortality among the patients with CAP. METHODS: This prospective, observational, single-center, cross-sectional study was conducted at the ED of Celal Bayar University Hafsa Sultan Hospital. Data were collected from patients with CAP at the ED. Eligible patients included to the study and their plasma Pro-ADM leves were determined. All patients were followed up for mortality within 28 days after ED presentation. RESULTS: A total of 90 patients (63.3% men) with CAP were enrolled in this study. All-cause mortality at the 28-day follow-up evaluation was 22.2%. Admission Pro-ADM levels were significantly higher in nonsurvivors compared with 28-day survivors (107.0±75.6 vs 45.7±21.2 ng/mL, P <0.001). Moreover, we determined that the optimal Pro-ADM cutoff for predicting 28-day mortality at the time of ED admission was 50 ng/mL, with 75.0% sensitivity and 21.4% specificity. CONCLUSION: Serum Pro-ADM level is valuable for predicting mortality and the severity of the disease among patients with CAP at ED admission. Thus, Pro-ADM might play a further role in the clinical assessment of the severityof CAP.