Capacidad de la región medial de la proadrenomedulina (MR-proADM) para predecir mala evolución clínica y estratificar el pronóstico en los pacientes adultos atendidos en urgencias por sospecha de infección.

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Title:	Capacidad de la región medial de la proadrenomedulina (MR-proADM) para predecir mala evolución clínica y estratificar el pronóstico en los pacientes adultos atendidos en urgencias por sospecha de infección.
Alternate Title:	Ability of midregional proadrenomedullin (MR-proADM) to predict poor clinical outcome and stratify prognosis in adult patients seen for suspected infection in the Emergency Department.
Authors:	de Rafael-González, Elena¹, Cabañas-Morafraile, Javier², Serrano-Martín, Laura³, Julián-Jiménez, Agustín^2,4, Torres-Fernández, María¹, Chaves-Prieto, Elia², Morell-Jurado, Laura¹, Esneider López-Forero, William², Francisca Calafell-Mas, María¹, Thomas-Balaguer Cordero, Álvaro², Remedios Asensio-Nieto, María¹, Nieto-Rojas, Isabel², Rubio-Díaz, Rafael², Heredero-Gálvez, Eva³, Carmen Lorenzo-Lozano, María¹, Canabal-Berlanga, Raúl²
Source:	Revista Española de Quimioterapia. ago2025, Vol. 38 Issue 4, p319-334. 16p.
Subjects:	INTENSIVE care units, LEUKOCYTE count, SEPTIC shock, RECEIVER operating characteristic curves, TREATMENT effectiveness, DEATH forecasting
Abstract (English):	Objectives: To analyze and compare the accuracy of midregional proadrenomedullin (MR-proADM) to predict poor clinical outcome (understood as progression to septic shock or admission to the Critical Care Unit -CCU-) and 30-day mortality in adult patients seen for suspected infection in the Emergency Department (ED). We also compared their performance with other biomarkers (C-reactive protein -CRP-, procalcitonin -PCT-, lactate and leukocyte count) and clinical scales widely used in routine practice (qSOFA, SRIS, NEWS-2). Methods: A prospective, observational and analytical study was carried out on adult patients who were treated in an ED with the clinical diagnosis of an infectious process. Follow-up was carried out for 30 days. The main outcome was a composite measure that included progression to septic shock or admission to the CCU and 30-day mortality. The predictive ability was analyzed with the area under the curve (AUC) of the receiver operating characteristic (ROC) and the values of sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of MR-proADM, PCR, PCT, lactate, leukocyte count and the clinical scales. Results: 214 patients were included, of whom 31 (14.5%) fulfilled the combined variable. The mean age was 68.6 (SD 20.75) years, 55.1% (118) were men. The MR-proADM concentration achieved the best AUC-ROC of 0.920 (95% CI: 0.850-0.989) compared to the other biomarkers and clinical scales. With a cut-off point (Cp) according to the Youden index > 2.105 nmol/L, a Se: 68%, Es: 98% and NPV: 97% were obtained. The NEWS-2 scale = 5 achieves an AUC-ROC of 0.733 (95% CI: 0.630-0.835) with a Se: 87%, Es: 55% and NPV: 96%. The mixed model (MR-proADM =2.1 nmol/l + NEWS-2 =5) improved the AUC-ROC to 0.849 (95% CI: 0.782-0.915) and Se: 68%, Es: 98%, PPV: 74% and NPV: 88%. Conclusions: In adult patients attended with clinical suspicion of infection in the ED, MR-proADM presents a high ability to predict poor clinical evolution (progression to septic shock or ICU admission) and 30-day mortality and performs better than PCT, lactate, CRP, leukocyte count and the clinical scales qSOFA, SRIS, NEWS-2. The combined model (MR-proADM =2.1 nmol/L + NEWS-2 =5) improves prediction of both MR-proADM and clinical scales. [ABSTRACT FROM AUTHOR]
Abstract (Spanish):	Objetivos: Analizar y comparar la precisión de la fracción media de la proadrenomedulina (MR-proADM) para predecir mala evolución clínica (entendida como progresión a shock séptico o ingreso en la unidad de cuidados intensivos -UCI-) y mortalidad a los 30 días en los pacientes adultos atendidos con sospecha clínica de infección en el Servicio de Urgencias (SU). Así como comparar su rendimiento con otros biomarcadores (proteína C reactiva -PCR-, procalcitonina -PCT-, lactato y recuento de leucocitos) y las escalas clínicas ampliamente utilizadas en la práctica habitual (qSOFA, SRIS, NEWS-2). Materiales y métodos: Estudio observacional, de cohortes, prospectivo y analítico de pacientes adultos atendidos en un SUH con el diagnóstico clínico de un proceso infeccioso. Se realizó un seguimiento durante 30 días. Como variable dependiente se consideró la variable combinada de resultado que incluía una progresión a shock séptico, el ingreso en UCI o mortalidad a 30 días. Se analizo' la capacidad predictiva con el a'rea bajo la curva (ABC) de la caracteri'stica operativa del receptor (COR) y los valores de sensibilidad (Se), especificidad (Es), valor predictivo positivo (VPP) y negativo (VPN) de la MR-proADM, PCR, PCT, lactato, recuento de leucocitos y de las escalas clínicas. Resultados: Se incluyó a 214 pacientes, de los que 31 (14,5%) cumplían la variable combinada. La edad media fue 68,6 (DE 20,75) años, el 55,1% (118) eran hombres. La MR-proADM mostró la mejor ABC-COR de 0,920 (IC 95%: 0,850-0,989) en com paración con el resto de biomarcadores y las escalas clínicas. Con un punto de corte (PC) según el índice de Youden > 2,105 nmol/L se obtiene una Se: 68%, Es: 98% y VPN: 97%. La escala NEWS-2 = 5 consigue un ABC-COR de 0,733 (IC 95%: 0,630-0,835) con una Se: 87%, Es: 55% y VPN:96%. En modelo combinado (MR-proADM =2,1 nmol/L + NEWS-2 =5) mejora la predicción con un ABC-COR de 0,849 (IC 95%: 0,782-0,915) y Se: 68%, Es: 98%, VPP: 74% y VPN: 88%. Conclusiones: En los pacientes adultos atendidos con sospecha clínica de infección en el SU, la MR-proADM presenta una gran capacidad para predecir mala evolución clínica (progresión a shock séptico o ingreso en UCI) y mortalidad a los 30 días y obtiene un mejor rendimiento que la PCT, lactato, PCR, recuento de leucocitos y las escalas clínicas qSOFA, SRIS, NEWS-2. El modelo combinado (MR-proADM =2,1 nmol/L + NEWS-2 =5) mejora la predicción tanto de MR-proADM como de las escalas clínicas. [ABSTRACT FROM AUTHOR]
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Database:	MedicLatina

Description
Abstract:	Objectives: To analyze and compare the accuracy of midregional proadrenomedullin (MR-proADM) to predict poor clinical outcome (understood as progression to septic shock or admission to the Critical Care Unit -CCU-) and 30-day mortality in adult patients seen for suspected infection in the Emergency Department (ED). We also compared their performance with other biomarkers (C-reactive protein -CRP-, procalcitonin -PCT-, lactate and leukocyte count) and clinical scales widely used in routine practice (qSOFA, SRIS, NEWS-2). Methods: A prospective, observational and analytical study was carried out on adult patients who were treated in an ED with the clinical diagnosis of an infectious process. Follow-up was carried out for 30 days. The main outcome was a composite measure that included progression to septic shock or admission to the CCU and 30-day mortality. The predictive ability was analyzed with the area under the curve (AUC) of the receiver operating characteristic (ROC) and the values of sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of MR-proADM, PCR, PCT, lactate, leukocyte count and the clinical scales. Results: 214 patients were included, of whom 31 (14.5%) fulfilled the combined variable. The mean age was 68.6 (SD 20.75) years, 55.1% (118) were men. The MR-proADM concentration achieved the best AUC-ROC of 0.920 (95% CI: 0.850-0.989) compared to the other biomarkers and clinical scales. With a cut-off point (Cp) according to the Youden index > 2.105 nmol/L, a Se: 68%, Es: 98% and NPV: 97% were obtained. The NEWS-2 scale = 5 achieves an AUC-ROC of 0.733 (95% CI: 0.630-0.835) with a Se: 87%, Es: 55% and NPV: 96%. The mixed model (MR-proADM =2.1 nmol/l + NEWS-2 =5) improved the AUC-ROC to 0.849 (95% CI: 0.782-0.915) and Se: 68%, Es: 98%, PPV: 74% and NPV: 88%. Conclusions: In adult patients attended with clinical suspicion of infection in the ED, MR-proADM presents a high ability to predict poor clinical evolution (progression to septic shock or ICU admission) and 30-day mortality and performs better than PCT, lactate, CRP, leukocyte count and the clinical scales qSOFA, SRIS, NEWS-2. The combined model (MR-proADM =2.1 nmol/L + NEWS-2 =5) improves prediction of both MR-proADM and clinical scales. [ABSTRACT FROM AUTHOR]
ISSN:	02143429
DOI:	10.37201/req/031.2025