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Observational Study
. 2019 Feb 22;8(11):e020337.
doi: 10.1136/bmjopen-2017-020337.

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

Sara Graziadio  1 , Rachel Amie O'Leary  1 , Deborah D Stocken  2   3   4 , Michael Power  1 , A Joy Allen  5 , A John Simpson  5 , David Ashley Price  1
Affiliations
Observational Study

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

Sara Graziadio et al. BMJ Open. .

Abstract

Objective: 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.

Design: Prospective observational study.

Setting: The Medical Admissions Suite of the Royal Victoria Infirmary, Newcastle.

Participants: 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.

Outcome measure: 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.

Results: 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 AUC to 0.69 (95% CI 0.63 to 0.76).

Conclusions: MR-proADM is potentially a clinically useful biomarker for deterioration in patients admitted to hospital with a mild to moderately severe acute illness, that is, with NEWS between 2 and 5. As a growing number of National Health Service hospitals are routinely recording the NEWS on their clinical information systems, further research should assess the practicality and use of developing a decision aid based on admission NEWS, MR-proADM level, and possibly other clinical data and other biomarkers that could further improve prognostic accuracy.

Keywords: internal medicine.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Patient recruitment process. AS, Assessment Suite, also called as Medical Admissions Unit (MAU); GP, general practitioner; MR-proADM, mid-regional pro-adrenomedullin; NEWS, National Early Warning Score.
Figure 2
Figure 2
(A) Prognostic accuracy for acuity increase. Predictor set a: NEWS; predictor set b: NEWS, MR-proADM; predictor set c: NEWS, MR-proADM, COPD/HF, interaction between MR-proADM and COPD/HF. (B) Comparisons as for panel (A) but for predicting a deterioration event. Predictor set c: NEWS, MR-proADM level, age2, other comorbidities. (C) Length of stay predicted by MR-proADM level. COPD, chronic obstructive pulmonary disease; HF, heart failure; MR-proADM, mid-regional pro-adrenomedullin; NEWS, National Early Warning Score.
See this image and copyright information in PMC

References

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