Enhancement of CURB65 Score with Proadrenomedullin (CURB65-A) for Outcome Prediction in Lower Respiratory Tract Infections: Derivation of a Clinical Algorithm

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Enhancement of CURB65 Score with Proadrenomedullin (CURB65-A) for Outcome Prediction in Lower Respiratory Tract Infections: Derivation of a Clinical Algorithm

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Title: Enhancement of CURB65 Score with Proadrenomedullin (CURB65-A) for Outcome Prediction in Lower Respiratory Tract Infections: Derivation of a Clinical Algorithm
Author: Albrich, Werner C; Dusemund, Frank; Christ-Crain, Mirjam; Zimmerli, Werner; Bregenzer, Thomas; Irani, Sarosh; Buergi, Ulrich; Mueller, Beat; Ruegger, Kristina; Reutlinger, Barbara; Schuetz, Philipp

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Citation: Albrich, Werner C, Frank Dusemund, Kristina Ruegger, Mirjam Christ-Crain, Werner Zimmerli, Thomas Bregenzer, Sarosh Irani, et al. 2011. Enhancement of CURB65 score with proadrenomedullin (CURB65-A) for outcome prediction in lower respiratory tract infections: Derivation of a clinical algorithm. BMC Infectious Diseases 11: 112.
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Abstract: Background: Proadrenomedullin (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. Methods: We 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. Results: CURB65 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 \(\leq\)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 \(\leq\)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. Conclusions: The 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 Registration: Procalcitonin-guided antibiotic therapy and hospitalisation in patients with lower respiratory tract infections: the prohosp study; isrctn.org Identifier: ISRCTN: ISRCTN95122877
Published Version: doi://10.1186/1471-2334-11-112
Other Sources: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3119069/pdf/
Terms of Use: This article is made available under the terms and conditions applicable to Other Posted Material, as set forth at http://nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of-use#LAA
Citable link to this page: http://nrs.harvard.edu/urn-3:HUL.InstRepos:8160876
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