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Panminerva Medica 2018 September;60(3):80-5

DOI: 10.23736/S0031-0808.18.03408-0


language: English

Multidimensional Prognostic Index and pro-adrenomedullin plasma levels as mortality risk predictors in older patients hospitalized with community-acquired pneumonia: a prospective study

Alberto PILOTTO 1 , Simone DINI 1, Nicola VERONESE 1, Julia DARAGJATI 2, Manuela MIOLO 3, Monica M. MION 3, Andrea FONTANA 4, Mario LO STORTO 2, Martina ZANINOTTO 3, Giada BRAGATO 3, Alberto CELLA 1, Paolo CARRARO 4, Filomena ADDANTE 5, Massimiliano COPETTI 5, Mario PLEBANI 3

1 Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genoa, Italy; 2 Department of Women and Children’s Health, University of Padua, Padua, Italy; 3 Department of Laboratory Medicine, Azienda ULSS 6 Euganea and Azienda Ospedaliera, Padua, Italy; 4 Department of Laboratory Medicine, Azienda ULSS 3 Serenissima, Venice, Italy; 5 Casa Sollievo della Sofferenza Institute for Research and Care, San Giovanni Rotondo, Foggia, Italy


BACKGROUND: To evaluate the prognostic accuracy of proadrenomedullin (proADM) in comparison with and in addition to the Multidimensional Prognostic Index (MPI), a validated predictive tool for mortality derived from a comprehensive geriatric assessment (CGA) to predict one-month mortality risk in older patients hospitalized with community-acquired pneumonia (CAP).
METHODS: All patients aged 65 years and older, consecutively admitted to an acute geriatric ward with a diagnosis of CAP from February to July 2012. At admission and at discharge they were submitted to a standard CGA in order to calculate MPI. Moreover, plasma samples were taken at baseline and after one, three and five days of hospitalization for the analysis of pro-ADM.
RESULTS: Fifty patients (mean age 86.2±7.5 years), with 31 at high risk of mortality (MPI-3) were enrolled. ProADM and MPI, both at admission and at discharge, were significant predictor of mortality. As expected, MPI at admission showed lower predictive accuracy than MPI at discharge (survival C-statistic 0.667 vs. 0.851). The addition of proADM to the MPI at admission significantly increased accuracy in predicting one-month mortality (C-statistics from 0.667 to 0.731, P=0.018 at baseline; from 0.667 to 0.733, P=0.008 at 1 day; from 0.633 to 0.724; P=0.019 at 3 days; from 0.667 to 0.828; P=0.003 at 5 days). Conversely, adding pro-ADM to the MPI at discharge did not significantly improve the model’s prognostic accuracy.
CONCLUSIONS: ProADM may significantly improve the prognostic accuracy of the MPI at admission in hospitalized elderly patients with CAP.

KEY WORDS: Community-acquired infections - Aged - Proadrenomedullin - Prognosis

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