Can mid-regional pro-adrenomedullin (MR-proADM) increase the prognostic accuracy of NEWS in predicting deterioration in patients admitted to hospital with mild to moderately severe illness? A prospective single-centre observational study

BMJ Open
Sara GraziadioDavid Ashley Price

Abstract

To assess the value added to the National Early Warning Score (NEWS) by mid-regional pro-adrenomedullin (MR-proADM) blood level in predicting deterioration in mild to moderately ill people. Prospective observational study. The Medical Admissions Suite of the Royal Victoria Infirmary, Newcastle. 300 adults with NEWS between 2 and 5 on admission. Exclusion criteria included receiving palliative care, or admitted for social reasons or self-harming. Patients were enrolled between September and December 2015, and followed up for 30 days after discharge. The primary outcome measure was the proportion of patients who, within 72 hours, had an acuity increase, defined as any combination of an increase of at least 2 in the NEWS; transfer to a higher-dependency bed or monitored area; death; or for those discharged from hospital, readmission for medical reasons. NEWS and MR-proADM together predicted acuity increase more accurately than NEWS alone, increasing the area under the curve (AUC) to 0.61 (95% CI 0.54 to 0.69) from 0.55 (95% CI 0.48 to 0.62). When the confounding effects of presence of chronic obstructive pulmonary disease or heart failure and interaction with MR-proADM were included, the prognostic accuracy further increased the A...Continue Reading

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Citations

Jun 13, 2020·Expert Review of Molecular Diagnostics·Ellen HaagPhilipp Schuetz
Oct 31, 2019·Critical Care : the Official Journal of the Critical Care Forum·Juan Gonzalez Del CastilloUNKNOWN INFURG-SEMES investigators
Apr 19, 2019·Critical Care : the Official Journal of the Critical Care Forum·Milo CullinanDavid Ashley Price

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Software Mentioned

NEWS
pROC
proADM
Hmisc
ggplot2
rms
PredictABEL
R
RStudio
MR

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