More Accurate Risk Classification

Optimize patient admission and site of treatment

Combining MR-proADM with current clinical risk assessment scores offers an easy to use algorithm for more precise risk management and greater confidence in site of care assignment. Defined cut-off values, in combination with existing CURB-65 scores, help better align patients into three defined risk categories, which can optimize decisions upon hospital admission and throughout the emergency department Ref-1,2 as well as support the early discharge of low risk patients. Thus, unnecessary clinical complications and healthcare resource consumption are minimised Ref-1.

Algorithm for applying MR-proADM cut-off valuesAlgorithm for applying MR-proADM cut-off values to the clinical risk assessment of LRTI patients (adapted from Albrich et al. 20119 Ref-1)

 

MR-proADM: More accurate patient risk classification

CURB-65 scores are grouped into low (0-1 points), intermediate (2 points) and high risk (3-5 points) categories and combined with MR-proADM cut-offs.

Data from 1359 patients with presumed LRTI (the observational OPTIMA I trial) was collected over six Swiss hospitals and analyzed in order to assess the association between levels of MR-proADM, the risk of adverse events and, ultimately, mortality Ref-3. A composite score was created by combining CURB-65 classes with MR-proADM cut-offs to give a CURB65-A score, in order to more accurately risk-stratify patients. Accordingly, the study made the following observations when risk assessment scores were combined with MR-proADM:

 

Enhanced safety of all out-patients

Enhanced safety of all out-patients

Of the 10.4 % (n=142) of patients that were originally classified as out-patients using CURB-65 alone, 38 % (n=54) should have actually been hospitalized (11.2 % as high risk, 26.7 % as intermediate risk), thus highlighting an increased risk to patient safety in the absence of the MR-proADM algorithm.

Decreased hospital admissions

Decreased hospital admissions

Of the 89.6 % (n=1217) of in-patients classified by CURB-65 alone, 17.9 % (n=218) could have been reclassified as out-patients if the CURB-65 score had been combined with MR-proADM. The financial implications of this for healthcare providers cannot be overstated. In the US, 2009 financial data for in-patient CAP treatment was shown to cost over 30 times more than that of out-patient treatment ($36,139 vs $1091) Ref-4.

 

MR-proADM: Safely increase out-patient numbers and decrease medical overruling

Increased out-patient numbers

Increased out-patient numbers

Using only CURB-65, 89.6 % of patients (n=1217) were treated as in-patients, and 10.4 % (n=142) treated as out-patients. After the combination of CURB-65 scores with MR-proADM, the number of out-patients increased to 22.5 % (n=306).

Increased out-patient numbers in an interventional trial

Increased out-patient numbers in an interventional trial

OPTIMA II was the first interventional study to evaluate the feasibility of adding MR-proADM to the CURB-65 score with regards to risk stratification Ref-5. A total of 313 patients with LRTI were enrolled over 3 centers, and the number of individuals considered for out-patient care was shown to more than double up to 19 % in the MR-proADM algorithm group, compared to 8.7 % in the OPTIMA I control group.

Decreased patient overruling

Decreased patient overruling

Mainly based on medical criteria (90.2 %), overruling occurred in 50.9 % of patients in the OPTIMA II control group after hospital admission, however, in the MR-proADM group the algorithm was overruled in only 27.4 % of patients on initial presentation (p < 0.001), thus giving physicians a greater degree of confidence in their overall disposition decision.

 

Benefits of out-patient treatment include:

Benefits of out-patient treatment include: 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 More accurate risk classification

Ref-1: 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-2: Aliberti S, Ramirez J, Cosentini R, et al. Low CURB-65 is of limited value in deciding discharge of patients with community-acquired pneumonia. Respir Med. Nov 2011;105(11):1732-17

Ref-3: 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-4: Broulette J, Yu H, Pyenson B, Iwasaki K, Sato R. The incidence rate and economic burden of community-acquired pneumonia in a working-age population. Am Health Drug Benefits. Sep 2013;6(8):494-503.

Ref-5: Albrich WC, Ruegger K, Dusemund F, et al. Biomarker-enhanced triage in respiratory infections: a proof-of-concept feasibility trial. Eur Respir J. Oct 2013;42(4):1064-1075.

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