Proadrenomedullin for prediction of early and mid-term mortality in patients hospitalized for community-acquired pneumonia
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Amaia Artaraz
,
Ane Uranga
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.
Acknowledgments
Authors would like to thank Tim Nicholson Language Services for improving the use of English in the manuscript.
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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”.
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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.
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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.
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Use of Large Language Models, AI and Machine Learning Tools: None declared.
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Conflict of interest: The authors state no conflict of interest.
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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.
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Data availability: Not applicable.
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Supplementary Material
This article contains supplementary material (https://doi.org/10.1515/cclm-2025-0481).
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