Prohormones for prediction of adverse medical outcome in community-acquired pneumonia and lower respiratory tract infections 英文参考文献.docVIP

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Prohormones for prediction of adverse medical outcome in community-acquired pneumonia and lower respiratory tract infections 英文参考文献.doc

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Prohormones for prediction of adverse medical outcome in community-acquired pneumonia and lower respiratory tract infections 英文参考文献

Schuetz et al. Critical Care 2010, 14:R106 /content/14/3/R106 RESEARCH Open Access Prohormones for prediction of adverse medical Research outcome in community-acquired pneumonia and lower respiratory tract infections Philipp Schuetz?1, Marcel Wolbers?2,3, Mirjam Christ-Crain1, Robert Thomann1,4, Claudine Falconnier1,5, Isabelle Widmer6, Stefanie Neidert6, Thomas Fricker7, Claudine Blum8, Ursula Schild1, Nils G Morgenthaler9, Ronald Schoenenberger4, Christoph Henzen6, Thomas Bregenzer8, Claus Hoess7, Martin Krause7, Heiner C Bucher2, Werner Zimmerli5, Beat Mueller*8 for the ProHOSP Study Group Abstract Introduction: Measurement of prohormones representing different pathophysiological pathways could enhance risk stratification in patients with community-acquired pneumonia (CAP) and other lower respiratory tract infections (LRTI). Methods: We assessed clinical parameters and five biomarkers, the precursor levels of adrenomedullin (ADM), endothelin-1 (ET1), atrial-natriuretic peptide (ANP), anti-diuretic hormone (copeptin), and procalcitonin in patients with LRTI and CAP enrolled in the multicenter ProHOSP study. We compared the prognostic accuracy of these biomarkers with the pneumonia severity index (PSI) and CURB65 (Confusion, Urea, Respiratory rate, Blood pressure, Age 65) score to predict serious complications defined as death, ICU admission and disease-specific complications using receiver operating curves (ROC) and reclassification methods. Results: During the 30 days of follow-up, 134 serious complications occurred in 925 (14.5%) patients with CAP. Both PSI and CURB65 overestimated the observed mortality (X2 goodness of fit test: P = 0.003 and 0.01). ProADM or proET1 alone had stronger discriminatory powers than the PSI or CURB65 score or any of either score components to predict serious complications. Adding proADM alone (or all five biomarkers jointly) to the PSI and CURB65 scores, significantly increased the area under the curve (AUC) for PSI