Article ; Online: Utilidad de la región medial de la pro-adrenomodulina para la detección de bacteriemia verdadera en pacientes mayores atendidos en urgencias por sospecha de infección.
Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia
2023 Volume 37, Issue 1, Page(s) 78–87
Abstract: Objective: The prediction of bacteremia in the emergency department (ER) is important for initial decision-making. The elderly population is a diagnosis challenge. The objective was to evaluate the accuracy of mid regional pro-adrenomedullin (MR-proADM) ...
| Title translation | Utility of the medial region of pro-adrenomodulin for the detection of true bacteremia in elderly patients treated in the emergency department for suspected infection. |
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| Abstract | Objective: The prediction of bacteremia in the emergency department (ER) is important for initial decision-making. The elderly population is a diagnosis challenge. The objective was to evaluate the accuracy of mid regional pro-adrenomedullin (MR-proADM) to identify true bacteremia (BV) in elderly patients attended in 3 hospital emergency departments. Methods: Observational study including patients ≥75 years of age or older attended in the ER for suspected infection in whom a blood culture (BC) was extracted. Sociodemographic, comorbidity, hemodynamic and analytical variables, biomarkers [MR-proADM, procalcitonin (PCT), C-reactive protein (CRP) and lactate] and final diagnosis were collected. The primary outcome was a true positive on a blood culture. Results: A total of 109 patients with a mean age of 83 (SD: 5.5) years were included. A final diagnosis of BV was obtained in 22 patients (20.2%). The independent variables to predict it were PCT (OR: 13.9; CI95%: 2.702-71.703; p=0.002), MR-proADM (OR: 4.081; CI95%: 1.026-16.225; p=0.046) and temperature (OR: 2.171; CI95%: 1.109-4.248; p=0.024). Considering the cut-off point for MR-proADM (2.13 mg/dl), a sensitivity (Se) of 73%, specificity (E) of 71%, a positive predictive value (PPV) of 39%, a negative predictive value (NPV) of 91%, a positive likelihood ratio (LHR+) of 2.53 and a negative likelihood ratio (LHR-) of 0.38; for PCT (0.76 mg/dl) a Se of 90%, E of 65%, PPV of 40%, NPV of 96%, LHR+ 2,64 and a LHR- of 0.14 were obtained. When combining both, a Se of 69%, E of 84%, PPV of 52%, NPV of 91%, LHR+ of 4.24 and LHR- of 0.38 were observed. Conclusions: Elevated levels of PCT and MR-proADM were independently associated with an increased risk of BV and the combination of both improves the accuracy to identify these patients. |
| MeSH term(s) | Humans ; Aged ; Aged, 80 and over ; Protein Precursors ; Biomarkers ; Procalcitonin ; Emergency Service, Hospital ; Bacteremia/diagnosis ; Bacteremia/drug therapy ; Prognosis |
| Chemical Substances | Protein Precursors ; Biomarkers ; Procalcitonin |
| Language | Spanish |
| Publishing date | 2023-12-18 |
| Publishing country | Spain |
| Document type | Observational Study ; English Abstract ; Journal Article |
| ZDB-ID | 1018135-0 |
| ISSN | 1988-9518 ; 0214-3429 |
| ISSN (online) | 1988-9518 |
| ISSN | 0214-3429 |
| DOI | 10.37201/req/110.2023 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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