Cargando…

Utility of Procalcitonin (PCT) and Mid regional pro-Adrenomedullin (MR-proADM) in risk stratification of critically ill febrile patients in Emergency Department (ED). A comparison with APACHE II score

BACKGROUND: The aim of our study was to evaluate the prognostic value of MR-proADM and PCT levels in febrile patients in the ED in comparison with a disease severity index score, the APACHE II score. We also evaluated the ability of MR-proADM and PCT to predict hospitalization. METHODS: This was an...

Descripción completa

Detalles Bibliográficos
Autores principales: Travaglino, Francesco, De Berardinis, Benedetta, Magrini, Laura, Bongiovanni, Cristina, Candelli, Marcello, Silveri, Nicolò Gentiloni, Legramante, Jacopo, Galante, Alberto, Salerno, Gerardo, Cardelli, Patrizia, Di Somma, Salvatore
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3447640/
https://www.ncbi.nlm.nih.gov/pubmed/22874067
http://dx.doi.org/10.1186/1471-2334-12-184
_version_ 1782244129359527936
author Travaglino, Francesco
De Berardinis, Benedetta
Magrini, Laura
Bongiovanni, Cristina
Candelli, Marcello
Silveri, Nicolò Gentiloni
Legramante, Jacopo
Galante, Alberto
Salerno, Gerardo
Cardelli, Patrizia
Di Somma, Salvatore
author_facet Travaglino, Francesco
De Berardinis, Benedetta
Magrini, Laura
Bongiovanni, Cristina
Candelli, Marcello
Silveri, Nicolò Gentiloni
Legramante, Jacopo
Galante, Alberto
Salerno, Gerardo
Cardelli, Patrizia
Di Somma, Salvatore
author_sort Travaglino, Francesco
collection PubMed
description BACKGROUND: The aim of our study was to evaluate the prognostic value of MR-proADM and PCT levels in febrile patients in the ED in comparison with a disease severity index score, the APACHE II score. We also evaluated the ability of MR-proADM and PCT to predict hospitalization. METHODS: This was an observational, multicentric study. We enrolled 128 patients referred to the ED with high fever and a suspicion of severe infection such as sepsis, lower respiratory tract infections, urinary tract infections, gastrointestinal infections, soft tissue infections, central nervous system infections, or osteomyelitis. The APACHE II score was calculated for each patient. RESULTS: MR-proADM median values in controls were 0.5 nmol/l as compared with 0.85 nmol/l in patients (P < 0.0001), while PCT values in controls were 0.06 ng/ml versus 0.56 ng/ml in patients (P < 0.0001). In all patients there was a statistically significant stepwise increase in MR-proADM levels in accordance with PCT values (P < 0.0001). MR-proADM and PCT levels were significantly increased in accordance with the Apache II quartiles (P < 0.0001 and P = 0.0012 respectively). In the respiratory infections, urinary infections, and sepsis-septic shock groups we found a correlation between the Apache II and MR-proADM respectively and MR-proADM and PCT respectively. We evaluated the ability of MR-proADM and PCT to predict hospitalization in patients admitted to our emergency departments complaining of fever. MR-proADM alone had an AUC of 0.694, while PCT alone had an AUC of 0.763. The combined use of PCT and MR-proADM instead showed an AUC of 0.79. CONCLUSIONS: The present study highlights the way in which MR-proADM and PCT may be helpful to the febrile patient’s care in the ED. Our data support the prognostic role of MR-proADM and PCT in that setting, as demonstrated by the correlation with the APACHE II score. The combined use of the two biomarkers can predict a subsequent hospitalization of febrile patients. The rational use of these two molecules could lead to several advantages, such as faster diagnosis, more accurate risk stratification, and optimization of the treatment, with consequent benefit to the patient and considerably reduced costs.
format Online
Article
Text
id pubmed-3447640
institution National Center for Biotechnology Information
language English
publishDate 2012
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-34476402012-09-21 Utility of Procalcitonin (PCT) and Mid regional pro-Adrenomedullin (MR-proADM) in risk stratification of critically ill febrile patients in Emergency Department (ED). A comparison with APACHE II score Travaglino, Francesco De Berardinis, Benedetta Magrini, Laura Bongiovanni, Cristina Candelli, Marcello Silveri, Nicolò Gentiloni Legramante, Jacopo Galante, Alberto Salerno, Gerardo Cardelli, Patrizia Di Somma, Salvatore BMC Infect Dis Research Article BACKGROUND: The aim of our study was to evaluate the prognostic value of MR-proADM and PCT levels in febrile patients in the ED in comparison with a disease severity index score, the APACHE II score. We also evaluated the ability of MR-proADM and PCT to predict hospitalization. METHODS: This was an observational, multicentric study. We enrolled 128 patients referred to the ED with high fever and a suspicion of severe infection such as sepsis, lower respiratory tract infections, urinary tract infections, gastrointestinal infections, soft tissue infections, central nervous system infections, or osteomyelitis. The APACHE II score was calculated for each patient. RESULTS: MR-proADM median values in controls were 0.5 nmol/l as compared with 0.85 nmol/l in patients (P < 0.0001), while PCT values in controls were 0.06 ng/ml versus 0.56 ng/ml in patients (P < 0.0001). In all patients there was a statistically significant stepwise increase in MR-proADM levels in accordance with PCT values (P < 0.0001). MR-proADM and PCT levels were significantly increased in accordance with the Apache II quartiles (P < 0.0001 and P = 0.0012 respectively). In the respiratory infections, urinary infections, and sepsis-septic shock groups we found a correlation between the Apache II and MR-proADM respectively and MR-proADM and PCT respectively. We evaluated the ability of MR-proADM and PCT to predict hospitalization in patients admitted to our emergency departments complaining of fever. MR-proADM alone had an AUC of 0.694, while PCT alone had an AUC of 0.763. The combined use of PCT and MR-proADM instead showed an AUC of 0.79. CONCLUSIONS: The present study highlights the way in which MR-proADM and PCT may be helpful to the febrile patient’s care in the ED. Our data support the prognostic role of MR-proADM and PCT in that setting, as demonstrated by the correlation with the APACHE II score. The combined use of the two biomarkers can predict a subsequent hospitalization of febrile patients. The rational use of these two molecules could lead to several advantages, such as faster diagnosis, more accurate risk stratification, and optimization of the treatment, with consequent benefit to the patient and considerably reduced costs. BioMed Central 2012-08-08 /pmc/articles/PMC3447640/ /pubmed/22874067 http://dx.doi.org/10.1186/1471-2334-12-184 Text en Copyright ©2012 Travaglino et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 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.
spellingShingle Research Article
Travaglino, Francesco
De Berardinis, Benedetta
Magrini, Laura
Bongiovanni, Cristina
Candelli, Marcello
Silveri, Nicolò Gentiloni
Legramante, Jacopo
Galante, Alberto
Salerno, Gerardo
Cardelli, Patrizia
Di Somma, Salvatore
Utility of Procalcitonin (PCT) and Mid regional pro-Adrenomedullin (MR-proADM) in risk stratification of critically ill febrile patients in Emergency Department (ED). A comparison with APACHE II score
title Utility of Procalcitonin (PCT) and Mid regional pro-Adrenomedullin (MR-proADM) in risk stratification of critically ill febrile patients in Emergency Department (ED). A comparison with APACHE II score
title_full Utility of Procalcitonin (PCT) and Mid regional pro-Adrenomedullin (MR-proADM) in risk stratification of critically ill febrile patients in Emergency Department (ED). A comparison with APACHE II score
title_fullStr Utility of Procalcitonin (PCT) and Mid regional pro-Adrenomedullin (MR-proADM) in risk stratification of critically ill febrile patients in Emergency Department (ED). A comparison with APACHE II score
title_full_unstemmed Utility of Procalcitonin (PCT) and Mid regional pro-Adrenomedullin (MR-proADM) in risk stratification of critically ill febrile patients in Emergency Department (ED). A comparison with APACHE II score
title_short Utility of Procalcitonin (PCT) and Mid regional pro-Adrenomedullin (MR-proADM) in risk stratification of critically ill febrile patients in Emergency Department (ED). A comparison with APACHE II score
title_sort utility of procalcitonin (pct) and mid regional pro-adrenomedullin (mr-proadm) in risk stratification of critically ill febrile patients in emergency department (ed). a comparison with apache ii score
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3447640/
https://www.ncbi.nlm.nih.gov/pubmed/22874067
http://dx.doi.org/10.1186/1471-2334-12-184
work_keys_str_mv AT travaglinofrancesco utilityofprocalcitoninpctandmidregionalproadrenomedullinmrproadminriskstratificationofcriticallyillfebrilepatientsinemergencydepartmentedacomparisonwithapacheiiscore
AT deberardinisbenedetta utilityofprocalcitoninpctandmidregionalproadrenomedullinmrproadminriskstratificationofcriticallyillfebrilepatientsinemergencydepartmentedacomparisonwithapacheiiscore
AT magrinilaura utilityofprocalcitoninpctandmidregionalproadrenomedullinmrproadminriskstratificationofcriticallyillfebrilepatientsinemergencydepartmentedacomparisonwithapacheiiscore
AT bongiovannicristina utilityofprocalcitoninpctandmidregionalproadrenomedullinmrproadminriskstratificationofcriticallyillfebrilepatientsinemergencydepartmentedacomparisonwithapacheiiscore
AT candellimarcello utilityofprocalcitoninpctandmidregionalproadrenomedullinmrproadminriskstratificationofcriticallyillfebrilepatientsinemergencydepartmentedacomparisonwithapacheiiscore
AT silverinicologentiloni utilityofprocalcitoninpctandmidregionalproadrenomedullinmrproadminriskstratificationofcriticallyillfebrilepatientsinemergencydepartmentedacomparisonwithapacheiiscore
AT legramantejacopo utilityofprocalcitoninpctandmidregionalproadrenomedullinmrproadminriskstratificationofcriticallyillfebrilepatientsinemergencydepartmentedacomparisonwithapacheiiscore
AT galantealberto utilityofprocalcitoninpctandmidregionalproadrenomedullinmrproadminriskstratificationofcriticallyillfebrilepatientsinemergencydepartmentedacomparisonwithapacheiiscore
AT salernogerardo utilityofprocalcitoninpctandmidregionalproadrenomedullinmrproadminriskstratificationofcriticallyillfebrilepatientsinemergencydepartmentedacomparisonwithapacheiiscore
AT cardellipatrizia utilityofprocalcitoninpctandmidregionalproadrenomedullinmrproadminriskstratificationofcriticallyillfebrilepatientsinemergencydepartmentedacomparisonwithapacheiiscore
AT disommasalvatore utilityofprocalcitoninpctandmidregionalproadrenomedullinmrproadminriskstratificationofcriticallyillfebrilepatientsinemergencydepartmentedacomparisonwithapacheiiscore