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Effectiveness of Proadrenomedullin Enhanced CURB65 Score Algorithm in Patients with Community-Acquired Pneumonia in “Real Life”, an Observational Quality Control Survey

1
Medical University Department, University of Basel, Kantonsspital Aarau, Tellstrasse, Aarau 5001, Switzerland
2
Department of Clinical Nursing Science, Kantonsspital Aarau, Tellstrasse, Aarau 5001, Switzerland
3
Division of Pulmonary Medicine, Kantonsspital Aarau, Tellstrasse, Aarau 5001, Switzerland
4
Department of Laboratory Medicine, Kantonsspital Aarau, Tellstrasse, Aarau 5001, Switzerland
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Department of Emergency Medicine, Kantonsspital Aarau, Tellstrasse, Aarau 5001, Switzerland
6
Division of Infectious Diseases and Hospital Hygiene, Cantonal Hospital St. Gallen, Rorschacherstrasse 95, St. Gallen CH-9007, Switzerland
*
Author to whom correspondence should be addressed.
These authors contributed equally to this paper.
J. Clin. Med. 2014, 3(1), 267-279; https://doi.org/10.3390/jcm3010267
Received: 31 December 2013 / Revised: 13 February 2014 / Accepted: 18 February 2014 / Published: 14 March 2014
Background: An intervention trial found a trend for shorter length of stay (LOS) in patients with community-acquired pneumonia (CAP) when the CURB65 score was combined with the prognostic biomarker proadrenomedullin (ProADM) (CURB65-A). However, the efficacy and safety of CURB65-A in real life situations remains unclear. Methods: From September, 2011, until April, 2012, we performed a post-study prospective observational quality control survey at the cantonal Hospital of Aarau, Switzerland of consecutive adults with CAP. The primary endpoint was length of stay (LOS) during the index hospitalization and within 30 days. We compared the results with two well-defined historic cohorts of CAP patients hospitalized in the same hospital with the use of multivariate regression, namely 83 patients in the observation study without ProADM (OPTIMA I) and the 169 patients in the intervention study (OPTIMA II RCT). Results: A total of 89 patients with confirmed CAP were included. As compared to patients with CURB65 only observed in the OPTIMA I study, adjusted regression analysis showed a significant shorter initial LOS (7.5 vs. 10.4 days; −2.32; 95% CI, −4.51 to −0.13; p = 0.04) when CURB65-A was used in clinical routine. No significant differences were found for LOS within 30 days. There were no significant differences in safety outcomes in regard to mortality and ICU admission between the cohorts. Conclusion: This post-study survey provides evidence that the use of ProADM in combination with CURB65 (CURB65-A) in “real life” situations reduces initial LOS compared to the CURB65 score alone without apparent negative effects on patient safety. View Full-Text
Keywords: biomarkers; proadrenomedullin; clinical scores; CURB65; pneumonia biomarkers; proadrenomedullin; clinical scores; CURB65; pneumonia
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Widmer, D.; Drozdov, D.; Rüegger, K.; Litke, A.; Arici, B.; Regez, K.; Guglielmetti, M.; Schild, U.; Conca, A.; Schäfer, P.; Kouegbe, R.B.; Reutlinger, B.; Blum, C.; Schuetz, P.; Irani, S.; Huber, A.; Bürgi, U.; Müller, B.; Albrich, W.C. Effectiveness of Proadrenomedullin Enhanced CURB65 Score Algorithm in Patients with Community-Acquired Pneumonia in “Real Life”, an Observational Quality Control Survey. J. Clin. Med. 2014, 3, 267-279.

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