MR-proADM in Lower Respiratory Tract Infections (LRTI)

More accurate risk assessment and disposition decision

Lower respiratory tract infections (LRTIs), which include community acquired pneumonia (CAP), chronic obstructive pulmonary disease (COPD) and acute bronchitis, are amongst the most frequent causes of hospitalisation Ref-1, with as many as 40 % of elderly CAP patients being hospitalized on arrival Ref-2, and an in-hospital COPD mortality rate of between 6-8 % Ref-3.

The initial assessment of disease severity and prediction of outcome is of extreme importance, in both clinical and financial terms, since it directly influences a patient’s site of treatment. Indeed, in-patient care can cost between 8 and 20 times more than out-patient treatment Ref-4, 5, depending on treatment location, with additional risks of nosocomial complications Ref-6. Consequently, risk assessment scoring systems such as the Pneumonia Severity Index (PSI) and CURB-65 for CAP, as well as BODE for COPD, have been developed to identify patients who are at risk of dying within 30 days of hospitalisation Ref-7, 8.

The importance of accurate risk assessment directly influences factors such as: Overall admission rates and treatment strategy; Length of stay (LOS) and determination of treatment location;  Allocation of healthcare resources; Therapeutic option guidance

Using these tools alone, significant numbers of patients may be admitted as in-patients in the emergency department or intensive care units when a less intensive treatment is adequate, thus placing additional burden and cost on the hospital. On the other hand, others may be discharged prematurely when a more intensive course of action is required, consequently putting patient safety at risk.

In combination with current risk assessment scores, biomarkers can serve as an additional tool in order to further improve risk assessment score accuracy, and more accurately determine the most appropriate site of care. Of the biomarkers currently available, MR-proADM best correlates to disease severity, the risk of developing adverse complications, and short- and mid-term mortality in lower tract respiratory infections, especially when combined with such risk assessment scoresRef-9-11.

A combination approach ultimately provides the physician with a more powerful risk assessment tool, allowing better decisions to be made regarding a patient’s health, and potentially resulting in an overall economic benefit to the hospital.

Benefits of accurate risk assessment: Reduction in the risk of associated healthcare infections and nosocomial complications; Greater availability of in demand resources, such as ED and ICU beds and physician time; Reduced financial costs compared to in-patient treatment; Increased patient satisfaction and comfort

 

References MR-proADM in lower respiratory tract infections (LRTI)

Ref-1: Grijalva CG, Nuorti JP, Arbogast PG, Martin SW, Edwards KM, Griffin MR. Decline in pneumonia admissions after routine childhood immunisation with pneumococcal conjugate vaccine in the USA: a time-series analysis. Lancet. Apr 7 2007;369(9568):1179-1186.

Ref-2: Jackson ML, Neuzil KM, Thompson WW, et al. The burden of community-acquired pneumonia in seniors: results of a population-based study. Clin Infect Dis. Dec 1 2004;39(11):1642-1650.

Ref-3: Groenewegen KH, Schols AM, Wouters EF. Mortality and mortality-related factors after hospitalization for acute exacerbation of COPD. Chest. Aug 2003;124(2):459-467.

Ref-4: Aliyu ZY, Aliyu MH, McCormick K. Determinants for hospitalization in " low-risk" community acquired pneumonia. BMC Infect Dis. Jun 17 2003;3:11.

Ref-5: Griffiths PD, Edwards MH, Forbes A, Harris RL, Ritchie G. Effectiveness of intermediate care in nursing-led in-patient units. Cochrane Database Syst Rev. 2007(2):CD002214.

Ref-6: Chalmers JD, Al-Khairalla M, Short PM, Fardon TC, Winter JH. Proposed changes to management of lower respiratory tract infections in response to the Clostridium difficile epidemic. J Antimicrob Chemother. Apr 2010;65(4):608-618.

Ref-7: Fine MJ, Auble TE, Yealy DM, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. Jan 23 1997;336(4):243-250.

Ref-8: Lim WS, van der Eerden MM, Laing R, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. May 2003;58(5):377-382.

Ref-9: Albrich WC, Dusemund F, Ruegger K, et al. Enhancement of CURB65 score with proadrenomedullin (CURB65-A) for outcome prediction in lower respiratory tract infections: derivation of a clinical algorithm. BMC Infect Dis. 2011;11:112.

Ref-10: Albrich WC, Ruegger K, Dusemund F, et al. Optimised patient transfer using an innovative multidisciplinary assessment in Kanton Aargau (OPTIMA I): an observational survey in lower respiratory tract infections. Swiss Med Wkly. 2011;141:w13237.

Ref-11: Kruger S, Ewig S, Giersdorf S, Hartmann O, Suttorp N, Welte T. Cardiovascular and inflammatory biomarkers to predict short- and long-term survival in community-acquired pneumonia: Results from the German Competence Network, CAPNETZ. Am J Respir Crit Care Med. Dec 1 2010;182(11):1426-1434.

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