Mid-regional pro-adrenomedullin and copeptin to predict short-term prognosis of COPD exacerbations: a multicenter prospective blinded study

被引:14
作者
Dres, Martin [1 ,2 ]
Hausfater, Pierre [3 ,4 ]
Foissac, Frantz [5 ,6 ]
Bernard, Maguy [7 ]
Joly, Luc-Marie [8 ]
Sebbane, Mustapha [9 ]
Philippon, Anne-Laure [3 ,4 ]
Gil-Jardine, Cedric [10 ]
Schmidt, Jeannot [11 ]
Maignan, Maxime [12 ]
Treluyer, Jean-Marc [13 ]
Roche, Nicolas [14 ,15 ]
机构
[1] Hop La Pitie Salpetriere, AP HP, Pulm & Crit Care Dept, Paris, France
[2] Univ Paris 06, Clin & Expt Resp Neurophysiol UMRS1158, Paris, France
[3] Hop La Pitie Salpetriere, AP HP, Emergency Dept, Paris, France
[4] UPMC Univ Paris06, Sorbonne Univ, GRC BIOSFAST 14, Paris, France
[5] Necker Cochin Hosp, AP HP, Clin Res Dept, Paris, France
[6] Sorbonne Paris Cite, EA 7323, Paris, France
[7] Hop La Pitie Salpetriere, AP HP, Dept Biochem, Paris, France
[8] Charles Nicolle Hosp, Emergency Dept, Rouen, France
[9] Lapeyronie Hosp, Dept Emergency Med, Montpellier, France
[10] Pellegrin Hosp, Emergency Dept, Bordeaux, France
[11] Gabriel Montpied Hosp, Emergency Dept, Clermont Ferrand, France
[12] Grenoble Univ Hosp, Emergency Dept, Grenoble, France
[13] Paris Descartes Univ, Hop Cochin, AP HP, Clin Res Dept, Paris, France
[14] Cochin Hosp, AP HP, Pulm Dept, Paris, France
[15] Paris Descartes Univ, Paris, France
来源
INTERNATIONAL JOURNAL OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE | 2017年 / 12卷
关键词
COPD; mid-regional pro-adrenomedullin; copeptin; biomarker; emergency department; OBSTRUCTIVE PULMONARY-DISEASE; C-REACTIVE PROTEIN; NATRIURETIC PEPTIDE; RISK STRATIFICATION; HOSPITAL MORTALITY; SURVIVAL; PLASMA; PROADRENOMEDULLIN; BIOMARKERS; IDENTIFICATION;
D O I
10.2147/COPD.S126400
中图分类号
R56 [呼吸系及胸部疾病];
学科分类号
摘要
Background: Exacerbations of COPD (ECOPD) are a frequent cause of emergency room (ER) visits. Predictors of early outcome could help clinicians in orientation decisions. In the current study, we investigated whether mid-regional pro-adrenomedullin (MR-proADM) and copeptin, in addition to clinical evaluation, could predict short-term outcomes. Patients and methods: This prospective blinded observational study was conducted in 20 French centers. Patients admitted to the ER for an ECOPD were considered for inclusion. A clinical risk score was calculated, and MR-proADM and copeptin levels were determined from a venous blood sample. The composite primary end point comprised 30-day death or transfer to the intensive care unit or a new ER visit. Results: A total of 379 patients were enrolled in the study, of whom 277 were eventually investigated for the primary end point that occurred in 66 (24%) patients. In those patients, the median (interquartile range [IQR]) MR-proADM level was 1.02 nmol/L (0.77-1.48) versus 0.83 nmol/L (0.63-1.07) in patients who did not meet the primary end point (P=0.0009). In contrast, copeptin levels were similar in patients who met or did not meet the primary end point (P=0.23). MR-proADM levels increased with increasing clinical risk score category: 0.74 nmol/L (0.57-0.89), 0.83 nmol/L (0.62-1.12) and 0.95 nmol/L (0.75-1.29) for the low-,intermediate-and high-risk categories, respectively (P<0.001). MR-proADM was independently associated with the primary end point (odds ratio, 1.65; 95% confidence interval[CI], 1.10-2.48; P=0.015). MR-proADM predicted the occurrence of primary end point with a sensitivity of 46% (95% CI, 33%-58%) and a specificity of 79% (95% CI, 74-84). Conclusion: MR-proADM but not copeptin was significantly associated with outcomes at 30 days, even after adjustment for clinical risk category. Overall, MR-proADM, alone or combined with the clinical risk score, was a moderate strong predictor of short-term outcomes.
引用
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页码:1047 / 1056
页数:10
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