PROGNOSTIC VALUE OF PRO-ADRENOMEDULLIN, PROCALCITONIN AND C-REACTIVE PROTEIN IN COMMUNITY ACQUIRED PNEUMONIA

Introduction: Various biomarkers are used to evaluate the severity and prognosis of community acquired pneumonia (CAP). Objectives: To study and compare the prognostic value of MR-proADM, PCT and CRP in predicting the severity and outcome of CAP. Methods: A prospective cohort study of 92 patients hospitalized with CAP in the Clinic of Pneumology and Phthisiatrics of MHAT "Saint Marina"-Varna in 2015 was conducted. The biomarkers were measured on admission. Midregional pro-adrenomedullin (MR-proADM) and procalcitonin (PCT) were measured by standard ELISA, and C-reactive protein (CRP) was determined by latex-enhanced immunoturbidimetric assay. CAP severity was assessed by CURB-65. Results: Patients were on average 59.2 +/- 16.8 years of age; 68.5% of them were male. The in-hospital mortality rate was 7.6%. The three biomarkers MR-proADM, PCT and CRP were significantly higher in non-survivors compared to survivors (0.918 +/- 0.045 ng/ml vs. 0.397 +/- 0.269ng/ml, p<0.001; 2.14 +/- 0.60ng/ml vs.1.12 +/- 0.68ng/ml, p<0.001 and 215.12 +/- 96.39 mg/L vs.175.74 +/- 221.5mg/L, p<0.05 respectively). In patients who needed intensive care, the biomarkers were also significantly higher than those in patients treated in the general hospital unit (0.509 +/- 0.336ng/ml vs.0.414 +/- 0.28ng/ml, p<0.05; 1.92 +/- 0.76 ng/ml vs.1.15 +/- 0.70ng/ml, p<0.05 and 221.98 +/- 100.34 mg/L vs.165.31 +/- 122.84 mg/L, p<0.05 resp.). MR-proADM and PCT showed a moderate correlation with the CURB-65 (1=0.33, p<0.01 and r=0.30, p<0.05 respectively). CRP did not correlate with the CURB-65 (r=0.10, p>0.05). Conclusion: MR-proADM, PCT and CRP were significantly higher in non-survivors and in patients treated in the intensive care unit. MR-proADM and PCT showed a moderate correlation with the CURB-65, while the correlation coefficient for MR-proADM was higher. CRP did not correlate with the CURB-65.