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. 2014 Jul;6(7):921-9.
doi: 10.3978/j.issn.2072-1439.2014.06.42.

Performance evaluation of MR-proadrenomedullin and other scoring systems in severe sepsis with pneumonia

Serdar Akpinar  1 , Kazım Rollas  1 , Ali Alagöz  1 , Fatih Seğmen  1 , Tuğrul Sipit  1
Affiliations

Performance evaluation of MR-proadrenomedullin and other scoring systems in severe sepsis with pneumonia

Serdar Akpinar et al. J Thorac Dis. 2014 Jul.

Abstract

Background: In sepsis, risk assessment is as crucial as early and accurate diagnosis. In this study, we aimed to evaluate the prognostic value of mid-regional proadrenomedullin (MR-proADM) with other scoring systems in severe sepsis and septic shock patients due to community acquired pneumonia (CAP).

Methods: Patients were divided into 2 groups as severe sepsis and septic shock due to CAP (group 1, n=31) and only CAP group (group 2, n=26). Serum MR-proADM, procalcitonin (PCT), C-reactive protein (CRP), and d-dimer level were analyzed. Acute Physiological and Chronic Health Evaluation (APACHE) II score, Sequential Organ Failure Assessment (SOFA) score, and Pneumonia Severity Index (PSI) were performed for all patients.

Results: There was no difference between groups in terms of serum MR-proADM levels (P=0.780). Serum MR-proADM was not found a significant value for the prediction of death within the 4 and 8 weeks in all patients. SOFA score was the most significant to predict mortality in 4 and 8 weeks (P<0.001). The combination of SOFA score and serum MR-proADM was a strong factor to predict death in 4 weeks (specifity 86.8% and sensitivity 66.7%). The combination of MR-proADM, SOFA score, and APACHE II score was found 75.0% sensitive and 71.4% specific to predict mortality within 4 weeks in group 1.

Conclusions: The MR-proADM does not correlate with mortality or disease severity to predict mortality. The combination of SOFA, APACHE II scores, and MR-proADM was efficient to predict prognosis and mortality rate in severe sepsis or septic shock patients.

Keywords: Proadrenomedullin (proADM); pneumonia; pneumonia severity index (PSI); scoring systems; sepsis.

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Figures

Figure 1
Figure 1
Distribution of procalcitonin (PCT) level in groups. Data are shown as means ± standard error of the mean.
Figure 2
Figure 2
Distribution of MR-proADM levels According to PSI. PSI, pneumonia severity index.
Figure 3
Figure 3
Distribution of MR-proADM levels according to survivor and non-survivor groups within 4- and 8-week.
Figure 4
Figure 4
Distribution of SOFA Scores According to PSI level. PSI, pneumonia severity index; SOFA, sequential organ failure assessment scores.
Figure 5
Figure 5
ROC curve for: sensitivity and specifity of all parameters and scoring systems for the prediction of mortality in 4-week and 8-week. APACHE II, acute physiological and chronic health evaluation; CRP, C-reactive protein; PSI, pneumonia severity index; SOFA, sequential organ failure assessment scores; PCT, Procalcitonin; proADM, proadrenomedullin.
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