Reduction of Short-term Complications and Mortality

The combination of MR-proADM with CURB-65 or PSI

When used in isolation, MR-proADM can significantly improve results for determining a patient’s risk of adverse clinical outcomes and short-term mortality, in comparison to the use of CURB-65 risk assessment scores alone. However, far higher values can be found when both CURB-65 and MR-proADM are combined Ref-1, thus providing the treating physician with a more accurate risk assessment tool.

This is also true when using the more complex PSI score as the clinical risk assessment tool. Indeed, the combination of MR-proADM and PSI can significantly increase the accuracy in predicting short-, mid- and long-term mortality Ref-2, as well as providing increased prediction accuracy over PSI alone for treatment failure Ref-3. In addition, the use of MR-proADM alone has been shown to be able to discriminate between each PSI or CURB-65 severity class Ref-2, as well as having a greater discriminatory power to predict serious complications compared to either PSI or CURB-65 scores Ref-4.

The significance of combining MR-proADM with CURB-65 or PSI risk assessment scores in terms of adverse event and short-term mortality prediction, therefore, cannot be overstated.

AUCs of the ROC analysis for CURB-65 and PSI risk assessment scoresAUCs of the ROC analysis for CURB-65 and PSI risk assessment scores, alone, and in combination with MR-proADM for 30 day mortality and overall adverse outcomes (CURB-65), and 30 and 90 day mortality (PSI). Results show a significant improvement in overall risk assessment scores when combined with MR-proADM


Decreased adverse effects across all risk categories

The combination of CURB-65 and MR-proADM has been shown to more accurately determine the risk of adverse effects, which can include the need for vasopressors, ARDS, ICU admission and mechanical ventilation, amongst others; across low, intermediate and high risk patient groups Ref-1. The early warning of the potential to develop adverse complications can therefore:

  • Increase patient safety
  • Enhance patient management through more accurately determining those patients in need of extra care
  • Alleviate any unnecessary financial burden from the healthcare provider

Accordingly, a 10.1 % decrease in the rate of 30 day complications in low risk patients, and a 10 % decrease in high risk patients can be achieved by combining CURB-65 scores with MR-proADM cut-offs, thus allowing the better identification of individuals with a potentially high risk of complications.

Decreased adverse effects across all risk categoriesAdverse effects (ICU admission, need for vasopressors, mechanical ventilation, ARDS, empyema, adverse reaction to antibiotics, LRTI relapse or persistence, all-cause mortality) when CURB-65 is used alone, and in combination with MR-proADM, evaluated 30 days after enrolment (n=146)


Reduced length of stay (LOS) using MR-proADM

Reduced LOS in an observational study

Reduced LOS in an observational study

A reduced LOS can help free up beds, minimize staff time, and more importantly, benefit a patient’s overall health status. During the OPTIMA I study, more than half the patients remained hospitalized after reaching medical stability, thus compromising patient safety and putting unnecessary strain on hospital resources. Combining CURB-65 with MR-proADM resulted in an impressive median LOS reduction of 34 % for low risk patients and 26 % for intermediate risk patients.

Reduced LOS in an interventional trial

Reduced LOS in an interventional trial

In the interventional OPTIMA II trial, the overall LOS (6.3 days) for the MR-proADM algorithm cohort was 2.1 days shorter than that observed in the non-biomarker aided OPTIMA I control group (8.4 days), which more accurately reflected standard day-to-day hospital life without biomarker aided risk stratification, as opposed to conditions generated in a tightly enforced study environment.

Reduced LOS in tightly controlled, study conditions

Reduced LOS in tightly controlled, study conditions

Nevertheless, a comparison of the OPTIMA II LOS control group with the OPTIMA II MR-proADM algorithm highlighted a LOS reduction of 0.5 days. In the USA alone, this could account for substantial cost savings of between $457 to $846 per episode, or $500 - $900 million annually, based on 2007 figures Ref-5. Further cost savings are likely to be found using current 2015 figures.

Overall in-patient LOS reduction for the combination of CURB-65 and MR-proADMOverall in-patient LOS reduction for the combination of CURB-65 and MR-proADM, compared to using CURB-65 alone (adapted from Albrich et al. 2011; Optima 1 study; overall LOS is calculated by addition of LOS before and LOS after medical stability)

References Reduction of short-term complications and mortality

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: Bello S, Lasierra AB, Minchole E, et al. Prognostic power of proadrenomedullin in community-acquired pneumonia is independent of aetiology. Eur Respir J. May 2012;39(5):1144-1155.

Ref-3: Christ-Crain M, Morgenthaler NG, Stolz D, et al. Pro-adrenomedullin to predict severity and outcome in community-acquired pneumonia [ISRCTN04176397]. Crit Care. 2006;10(3):R96.

Ref-4: Schuetz P, Wolbers M, Christ-Crain M, et al. Prohormones for prediction of adverse medical outcome in community-acquired pneumonia and lower respiratory tract infections. Crit Care. 2010;14(3):R106.

Ref-5: Raut M, Schein J, Mody S, Grant R, Benson C, Olson W. Estimating the economic impact of a half-day reduction in length of hospital stay among patients with community-acquired pneumonia in the US. Curr Med Res Opin. Sep 2009;25(9):2151-2157.

thermo scientific applied biosystems invitrogen fisher scientific unity lab service