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Proadrenomedullin for prediction of early and mid-term mortality in patients hospitalized for community-acquired pneumonia

  • Amaia Artaraz ORCID logo EMAIL logo , Ane Uranga , Ana Jódar , Urko Aguirre , José María Quintana , Carmen Mar , Rosario Menéndez , Javier Aspa , Salvador Bello , Pedro Pablo España and Aitor Ballaz
Published/Copyright: September 8, 2025
Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 64 Issue 1

Abstract

Objectives

Our study sought to determine the usefulness of biomarkers of systemic inflammation (C-reactive protein (CRP), procalcitonin (PCT) and proadrenomedullin (proADM)) on hospital admission, as compared to the CURB65 score, for predicting 30- and 90-day mortality in patients hospitalized for community acquired pneumonia (CAP).

Methods

Observational, prospective study of adults admitted for CAP in four Spanish teaching hospitals. Disease severity was determined within the first 24 h of diagnosis, using the CURB65 score. CRP, PCT and proADM levels were assessed from samples obtained in the Emergency Department (ED). We compared the capacity of the different biomarkers and the CURB65 score to predict pneumonia-related 30- and 90-day mortality.

Results

A total of 956 patients hospitalized with CAP were included, 462 in the internal and 494 in the external sample. Of the biomarkers, proADM showed the greatest AUC for predicting 30- and 90-day mortality (0.80 and 0.76 respectively). Mortality at 30 and 90 days increased as proADM levels rose. When proADM was used as a continuous variable, CURB65 showed a similar predictive capacity (AUC 0.80) to both crude and age-adjusted proADM (AUC 0.80 and 0.83 respectively) for 30-day mortality. The same was also true for 90-day mortality. However, proADM used as a categorical variable had a greater predictive capacity for 90-day mortality than the CURB65 score (<0.001).

Conclusions

Amongst patients admitted for CAP, the use of proADM obtained in the ED may be useful for identifying patients at greatest risk of mortality, with a similar predictive capacity to the CURB65 score.

Keywords: community acquired pneumonia; prognosis; biomarkers of systemic inflammation; proadrenodemullin; mortality
Corresponding author: Amaia Artaraz, Respiratory Department, Galdakao-Usansolo University Hospital, Galdakao, Bizkaia, Spain, E-mail:

Acknowledgments

Authors would like to thank Tim Nicholson Language Services for improving the use of English in the manuscript.

  1. Research ethics: Our study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). Date of RBI: 21/01/2010 “Markers of inflammation in community-acquired pneumonia: analysis of their evolution and short- and medium-term predictive capacity. Subproject 2”.

  2. Informed consent: Verbal informed consent was obtained from all individuals included in this study, or their legal guardians or wards. Given that this is an observational study, with no additional medical intervention or modification of standard treatment, and considering that the data to be collected are obtained from the medical history and clinical interview without invasive implications, the use of verbal informed consent is proposed. This will be granted by each patient or their legal representative, and documented in the study records by the principal investigator. This method has been previously validated by the corresponding Ethics Committee, in accordance with the ethical principles of the Declaration of Helsinki and applicable local regulations.

  3. Author contributions: PPE, AU, RM, JA, SB contributed to the study design, data collection and data interpretation. AA wrote the manuscript. PPE, RM, JA, SB took responsibility for study design, data integrity review, editing and approval the final version. UA carried out data analysis and review the manuscript. JMQ contributed to the study design, review and approval the final version. AJ, AB, CM, RM, JA and SB contributed substantially to acquisition and interpretation of data. All authors reviewed critically the manuscript. All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  4. Use of Large Language Models, AI and Machine Learning Tools: None declared.

  5. Conflict of interest: The authors state no conflict of interest.

  6. Research funding: It should be mentioned that Thermo FisherScientific subsidized our proadrenomedullin reagents. Thermo Fisher Scientific is a leading global life sciences company, offering a broad range of products and services for research, diagnostics, and industrial applications. It manufactures and distributes laboratory equipment, reagents, software, and services, and also offers research solutions in areas such as molecular biology, proteomics, and clinical diagnostics.

  7. Data availability: Not applicable.

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Supplementary Material

This article contains supplementary material (https://doi.org/10.1515/cclm-2025-0481).

Received: 2025-04-18
Accepted: 2025-08-30
Published Online: 2025-09-08
Published in Print: 2026-01-27

© 2025 Walter de Gruyter GmbH, Berlin/Boston

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https://doi.org/10.1515/cclm-2025-0481
Keywords for this article
community acquired pneumonia; prognosis; biomarkers of systemic inflammation; proadrenodemullin; mortality

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Keeping pace with patient safety by developing and qualifying higher-order reference measurement procedures for laboratory measurement standardization
  4. Review
  5. The role of AI in pre-analytical phase – use cases
  6. Opinion Paper
  7. Total laboratory automation: fit for its intended purposes?
  8. Guidelines and Recommendations
  9. EFLM checklist for the assessment of AI/ML studies in laboratory medicine: enhancing general medical AI frameworks for laboratory-specific applications
  10. Candidate Reference Measurement Procedures and Materials
  11. An isotope dilution-liquid chromatography-tandem mass spectrometry-based candidate reference measurement procedure for the quantification of cortisol in human serum and plasma
  12. Isotope dilution-liquid chromatography-tandem mass spectrometry-based candidate reference measurement procedures for the quantification of 24(R),25-dihydroxyvitamin D2 and 24(R),25-dihydroxyvitamin D3 in human serum and plasma
  13. An isotope dilution-liquid chromatography-tandem mass spectrometry-based candidate reference measurement procedure for the quantification of cortisone in human serum and plasma
  14. Candidate reference measurement procedure based on isotope dilution-two dimensional-liquid chromatography-tandem mass spectrometry for the quantification of androstenedione in human serum and plasma
  15. An isotope dilution-liquid chromatography-tandem mass spectrometry-based candidate reference measurement procedure for the quantification of 17β-estradiol in human serum and plasma
  16. Isotope dilution-liquid chromatography-tandem mass spectrometry-based candidate reference measurement procedures for the quantification of total and free phenytoin in human serum and plasma
  17. An isotope dilution-liquid chromatography-tandem mass spectrometry based candidate reference measurement procedure for the simultaneous quantification of 25-hydroxyvitamin D3 and 25-hydroxyvitamin D2 in human serum and plasma
  18. General Clinical Chemistry and Laboratory Medicine
  19. Quality assurance using patient split samples: recommendations for primary healthcare laboratories
  20. Age distorts the interpretation of FIB-4
  21. Not all anti-parietal cell antibody tests are equal for diagnosing pernicious anemia
  22. Impact of renal and hepatic function on dihydropyrimidine dehydrogenase phenotype assessed by enzyme activity in peripheral blood mononuclear cells and uracilemia
  23. Fecal leukocyte esterase levels predict endoscopic severity as an alternative biomarker in inflammatory bowel disease
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  25. CA-125 glycovariant assays enhance diagnostic sensitivity in the detection of epithelial ovarian cancer
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  31. Comparison of seven different enzymatic methods for serum glycated albumin in pregnant women: a multicenter study
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  34. Proadrenomedullin for prediction of early and mid-term mortality in patients hospitalized for community-acquired pneumonia
  35. Annual Reviewer Acknowledgment
  36. Reviewer Acknowledgment
  37. Letters to the Editor
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