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, РСТ 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 (РСТ) 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, РСТ and CRP were significantly higher in non-survivors compared to survivors (0.918±0.045 ng/ml vs. 0.397±0.269ng/ml, р<0.001; 2.14±0.60ng/ml vs. 1.12±0.68ng/ml, р<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, р<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 РСТ showed a moderate correlation with the CURB-65 (r=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, РСТ and CRP were significantly higher in non-survivors and in patients treated in the intensive care unit. MR-proADM and РСТ 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.