Biomarker-enhanced triage in respiratory infections: a proof-of-concept feasibility trial

Abstract

Concerns about inadequate performance and complexity limit routine use of clinical risk scores in lower respiratory tract infections. Our aim was to study feasibility and effects of adding the biomarker proadrenomedullin (proADM) to the confusion, urea >7 mmol·L−1, respiratory rate ≥30 breaths·min−1, blood pressure <90 mmHg (systolic) or ≤60 mmHg (diastolic), age ≥65 years (CURB-65) score on triage decisions and length of stay.In a randomised controlled proof-of-concept intervention trial, triage and discharge decisions were made for adults with lower respiratory tract infection according to interprofessional assessment using medical and nursing risk scores either without (control group) or with (proADM group) knowledge of proADM values, measured on admission, and on days 3 and 6. An adjusted generalised linear model was calculated to investigate the effect of our intervention.On initial presentation the algorithms were overruled in 123 (39.3%) of the cases. Mean length of stay tended to be shorter in the proADM (n=154, 6.3 days) compared with the control group (n=159, 6.8 days; adjusted regression coefficient -0.19, 95% CI -0.41–0.04; p=0.1). This trend was robust in subgroup analyses and for overall length of stay within 90 days (7.2 versus 7.9 days; adjusted regression coefficient -0.18, 95% CI -0.40–0.05; p=0.13). There were no differences in adverse outcomes or readmission.Logistic obstacles and overruling are major challenges to implement biomarker-enhanced algorithms in clinical settings and need to be addressed to shorten length of stay.

MR-proADM Predicts Exercise Capacity and Survival Superior to Other Biomarkers in PH

“…In community-acquired pneumonia, MR-proADM was prospectively compared to CT-proET1, MR-proANP, and copeptin and showed the best prognostic performance [17]. In acute respiratory tract infection, a cutoff of\0.75 nmol/l has been proposed to rule out and a cutoff of [1.5 nmol/l to rule in complications and risk of death [46,47]. Taken together, these data resemble our study findings, demonstrating for the first time the prognostic accuracy of MRproADM in patients with PH, and they support our proposed cutoff of 1.08 nmol/l.…”

Midregional proadrenomedullin for prognosis in community-acquired pneumonia: A systematic review

“…There was no significant difference in length of stay between the 2 groups. A limitation of this trial was that the study algorithm was overruled in 39.3% of the patients at presentation and in 34.5% during hospitalization [20].…”

Can biomarkers help us to better diagnose and manage sepsis?

“…It belongs to the calcitonin peptide superfamily and is ubiquitously expressed in the body including sepsis, respiratory infections and pneumonia, and also heart failure and myocardial infarction [34,35]. Importantly, ProADM has been shown to improve clinical pneumonia risk scores [36], and in a pilot intervention study, tended to decrease in length of stay without increased risk for readmissions by improving physicians admission and early discharge decisions [37].…”