Enhancement of CURB65 score with proadrenomedullin (CURB65-A) for outcome prediction in lower respiratory tract infections: Derivation of a clinical algorithm

BMC Infectious Diseases

Research Article

Ulrich Buergi¹  Thomas Bregenzer²  Mirjam Christ-Crain³  Werner Zimmerli⁴  Barbara Reutlinger⁵  Sarosh Irani⁶  Philipp Schuetz⁷  Werner C Albrich⁸  Kristina Rüegger⁸  Beat Mueller⁸  Frank Dusemund⁸ 

[1] Department of Emergency Medicine, Kantonsspital Aarau, Switzerland;Department of Infectious Diseases, Kantonsspital Aarau, Switzerland;Department of Internal Medicine, Division of Endocrinology, Diabetes and Clinical Nutrition, University Hospital Basel, Switzerland;Department of Internal Medicine, Kantonsspital Liestal, Basel University Medical Clinic, Switzerland;Department of Nursing, Kantonsspital Aarau, Switzerland;Department of Pulmonary Medicine, Kantonsspital Aarau, Switzerland;Harvard School of Public Health, Boston, (MA), USA;Medical University Department of the University of Basel, Kantonsspital Aarau, Switzerland;

关键词: Chronic Obstructive Pulmonary Disease;    Intensive Care Unit Admission;    Lower Respiratory Tract Infection;    Outpatient Treatment;    Pneumonia Severity Index;   

DOI  :  10.1186/1471-2334-11-112

 received in 2010-10-15, accepted in 2011-05-03,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundProadrenomedullin (ProADM) confers additional prognostic information to established clinical risk scores in lower respiratory tract infections (LRTI). We aimed to derive a practical algorithm combining the CURB65 score with ProADM-levels in patients with community-acquired pneumonia (CAP) and non-CAP-LRTI.MethodsWe used data of 1359 patients with LRTI enrolled in a multicenter study. We chose two ProADM cut-off values by assessing the association between ProADM levels and the risk of adverse events and mortality. A composite score (CURB65-A) was created combining CURB65 classes with ProADM cut-offs to further risk-stratify patients.ResultsCURB65 and ProADM predicted both adverse events and mortality similarly well in CAP and non-CAP-LRTI. The combined CURB65-A risk score provided better prediction of death and adverse events than the CURB65 score in the entire cohort and in CAP and non-CAP-LRTI patients. Within each CURB65 class, higher ProADM-levels were associated with an increased risk of adverse events and mortality. Overall, risk of adverse events (3.9%) and mortality (0.65%) was low for patients with CURB65 score 0-1 and ProADM ≤0.75 nmol/l (CURB65-A risk class I); intermediate (8.6% and 2.6%, respectively) for patients with CURB65 score of 2 and ProADM ≤1.5 nmol/l or CURB classes 0-1 and ProADM levels between 0.75-1.5 nmol/L (CURB65-A risk class II), and high (21.6% and 9.8%, respectively) for all other patients (CURB65-A risk class III). If outpatient treatment was recommended for CURB65-A risk class I and short hospitalization for CURB65-A risk class II, 17.9% and 40.8% of 1217 hospitalized patients could have received ambulatory treatment or a short hospitalization, respectively.ConclusionsThe new CURB65-A risk score combining CURB65 risk classes with ProADM cut-off values accurately predicts adverse events and mortality in patients with CAP and non-CAP-LRTI. Additional prospective cohort or intervention studies need to validate this score and demonstrate its safety and efficacy for the management of patients with LRTI.Trial RegistrationProcalcitonin-guided antibiotic therapy and hospitalisation in patients with lower respiratory tract infections: the prohosp study; isrctn.org Identifier: ISRCTN: ISRCTN95122877

【 授权许可】

Unknown   
© Albrich et al; licensee BioMed Central Ltd. 2011. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.