Multidimensional Prognostic Index and pro-adrenomedullin plasma levels as mortality risk predictors in older patients hospitalized with community-acquired pneumonia: a prospective study

Panminerva Med. 2018 Sep;60(3):80-85. doi: 10.23736/S0031-0808.18.03408-0. Epub 2018 Mar 15.

Abstract

Background: To evaluate the prognostic accuracy of proadrenomedullin (proADM) in comparison with and in addition to the Multidimensional Prognostic Index (MPI), a validated predictive tool for mortality derived from a comprehensive geriatric assessment (CGA) to predict one-month mortality risk in older patients hospitalized with community-acquired pneumonia (CAP).

Methods: All patients aged 65 years and older, consecutively admitted to an acute geriatric ward with a diagnosis of CAP from February to July 2012. At admission and at discharge they were submitted to a standard CGA in order to calculate MPI. Moreover, plasma samples were taken at baseline and after one, three and five days of hospitalization for the analysis of pro-ADM.

Results: Fifty patients (mean age 86.2±7.5 years), with 31 at high risk of mortality (MPI-3) were enrolled. ProADM and MPI, both at admission and at discharge, were significant predictor of mortality. As expected, MPI at admission showed lower predictive accuracy than MPI at discharge (survival C-statistic 0.667 vs. 0.851). The addition of proADM to the MPI at admission significantly increased accuracy in predicting one-month mortality (C-statistics from 0.667 to 0.731, P=0.018 at baseline; from 0.667 to 0.733, P=0.008 at 1 day; from 0.633 to 0.724; P=0.019 at 3 days; from 0.667 to 0.828; P=0.003 at 5 days). Conversely, adding pro-ADM to the MPI at discharge did not significantly improve the model's prognostic accuracy.

Conclusions: ProADM may significantly improve the prognostic accuracy of the MPI at admission in hospitalized elderly patients with CAP.

MeSH terms

  • Adrenomedullin / blood*
  • Aged
  • Aged, 80 and over
  • Community-Acquired Infections / blood
  • Community-Acquired Infections / diagnosis*
  • Community-Acquired Infections / mortality*
  • Female
  • Geriatric Assessment
  • Humans
  • Male
  • Patient Admission
  • Patient Discharge
  • Pneumonia / blood
  • Pneumonia / diagnosis*
  • Pneumonia / mortality*
  • Predictive Value of Tests
  • Prognosis
  • Proportional Hazards Models
  • Prospective Studies
  • Protein Precursors / blood*
  • Risk Factors
  • Severity of Illness Index

Substances

  • Protein Precursors
  • proadrenomedullin
  • Adrenomedullin