Maaike Zuur-Telgen

Stable-State Midrange-Proadrenomedullin Level Is a Strong Predictor of Mortality in Patients With COPD

ABSTRACT BACKGROUND Midrange-proadrenomedullin (MR-proADM) has been shown to be elevated in patients hospitalized for an acute exacerbation of COPD (AECOPD) and in patients with community acquired pneumonia. MR-proADM when measured during AECOPD has also been shown to be a predictor for mortality, we hypothesized that MR-proADM levels measured in a stable state could also predict mortality. METHODS We included 181 patients in whom we had paired plasma samples for MR-proADM determinations during stable state and at hospitalization for AECOPD when they also produced sputum. Time to death or censoring was compared between patients with MR-proADM above or below the median of 0.71 nmol/L. The predictive value of MR-proADM for survival was determined by calculating the C statistic. RESULTS COPD patients with MR-proADM levels > 0.71 nmol/L in stable state had a 3-fold higher risk of dying than patients with MR-proADM levels < 0.71 nmol/L (HR 2.98 (95% CI 1.51-5.90); C statistic 0.76). The corrected Odds Ratio for one year mortality was 8.90 (95% CI 1.94 - 44.6) in patients with high MR-proADM levels measured in stable state, compared to patients with low levels. CONCLUSIONS MR-proADM measured in stable state showed to be a strong predictor for mortality in COPD patients. MR-proADM is far more convenient to measure than other predictors for mortality in COPD such as the BODE score.BACKGROUND Midrange-proadrenomedullin (MR-proADM) has been shown to be elevated in patients hospitalized for an acute exacerbation of COPD (AECOPD) and in patients with community-acquired pneumonia. When measured during AECOPDs, MR-proADM has also been shown to be a predictor of mortality. We hypothesized that MR-proADM levels measured in a stable state could also predict mortality. METHODS We included 181 patients in whom we had paired plasma samples for MR-proADM determinations during a stable state and at hospitalization for an AECOPD when they also produced sputum. Time to death or censoring was compared between patients with MR-proADM above or below the median of 0.71 nmol/L. The predictive value of MR-proADM for survival was determined by calculating the C statistic. RESULTS Patients with COPD and MR-proADM levels > 0.71 nmol/L in the stable state had a threefold-higher risk of dying than did patients with MR-proADM levels < 0.71 nmol/L (hazard ratio, 2.98 [95% CI, 1.51-5.90]; C statistic, 0.76). The corrected OR for 1-year mortality was 8.90 (95% CI, 1.94-44.6) in patients with high MR-proADM levels measured in the stable state, compared with patients with low levels measured in the stable state. CONCLUSIONS MR-proADM measured in the stable state appeared to be a strong predictor of mortality in patients with COPD. MR-proADM is far easier to measure than other predictors of mortality in COPD, such as BMI, airflow obstruction, dyspnea, and exercise capacity score.

Stable state MR-proadrenomedullin level is a strong predictor for mortality in COPD patients.

ABSTRACT BACKGROUND Midrange-proadrenomedullin (MR-proADM) has been shown to be elevated in patients hospitalized for an acute exacerbation of COPD (AECOPD) and in patients with community acquired pneumonia. MR-proADM when measured during AECOPD has also been shown to be a predictor for mortality, we hypothesized that MR-proADM levels measured in a stable state could also predict mortality. METHODS We included 181 patients in whom we had paired plasma samples for MR-proADM determinations during stable state and at hospitalization for AECOPD when they also produced sputum. Time to death or censoring was compared between patients with MR-proADM above or below the median of 0.71 nmol/L. The predictive value of MR-proADM for survival was determined by calculating the C statistic. RESULTS COPD patients with MR-proADM levels > 0.71 nmol/L in stable state had a 3-fold higher risk of dying than patients with MR-proADM levels < 0.71 nmol/L (HR 2.98 (95% CI 1.51-5.90); C statistic 0.76). The corrected Odds Ratio for one year mortality was 8.90 (95% CI 1.94 - 44.6) in patients with high MR-proADM levels measured in stable state, compared to patients with low levels. CONCLUSIONS MR-proADM measured in stable state showed to be a strong predictor for mortality in COPD patients. MR-proADM is far more convenient to measure than other predictors for mortality in COPD such as the BODE score.BACKGROUND Midrange-proadrenomedullin (MR-proADM) has been shown to be elevated in patients hospitalized for an acute exacerbation of COPD (AECOPD) and in patients with community-acquired pneumonia. When measured during AECOPDs, MR-proADM has also been shown to be a predictor of mortality. We hypothesized that MR-proADM levels measured in a stable state could also predict mortality. METHODS We included 181 patients in whom we had paired plasma samples for MR-proADM determinations during a stable state and at hospitalization for an AECOPD when they also produced sputum. Time to death or censoring was compared between patients with MR-proADM above or below the median of 0.71 nmol/L. The predictive value of MR-proADM for survival was determined by calculating the C statistic. RESULTS Patients with COPD and MR-proADM levels > 0.71 nmol/L in the stable state had a threefold-higher risk of dying than did patients with MR-proADM levels < 0.71 nmol/L (hazard ratio, 2.98 [95% CI, 1.51-5.90]; C statistic, 0.76). The corrected OR for 1-year mortality was 8.90 (95% CI, 1.94-44.6) in patients with high MR-proADM levels measured in the stable state, compared with patients with low levels measured in the stable state. CONCLUSIONS MR-proADM measured in the stable state appeared to be a strong predictor of mortality in patients with COPD. MR-proADM is far easier to measure than other predictors of mortality in COPD, such as BMI, airflow obstruction, dyspnea, and exercise capacity score.

Stable State Proadrenomedullin Level in COPD Patients: A Validation Study

ABSTRACT In patients with stable COPD, proadrenomedullin (MR-proADM) has been shown to be a good predictor for mortality. This study aims to provide an external validation of earlier observed cut-off values used by Zuur-Telgen et al. and Stolz.et al. in COPD patients in stable state and at hospitalization for an acute exacerbation of COPD (AECOPD). From the COMIC cohort study we included 545 COPD patients with a blood sample obtained in stable state (n = 490) and/or at hospitalization for an AECOPD (n = 101). Time to death was compared between patients with MR-proADM cut-off scores 0.71 and 0.75 nmol/L for stable state or 0.79 and 0.84 nmol/l for AECOPD. The predictive value of MR-proADM for survival was represented by the C statistic. Risk ratios were corrected for sex, age, BMI, presence of heart failure, and GOLD stage. Patients above the cut-off of 0.75 nmol/l had a 2-fold higher risk of dying than patient below this cut-off (95% CI: 1.20–3.41). The cut-off of 0.71 nmol/l showed only a borderline significantly higher risk of 1.67 (95% CI: 0.98–2.85). The corrected odds ratios for one-year mortality were 3.15 (95% CI 1.15–8.64) and 3.70 (95% CI 1.18–11.6) in patients with MR-proADM levels above versus below the cut-off of respectively 0.75 and 0.71 nmol/l measured in stable state. MR-proADM levels in samples at hospitalization for an AECOPD were not predictive for mortality in this validation cohort. MR-proADM in stable state is a powerful predictor for mortality.

Stable-State Midrange Proadrenomedullin Is Associated With Severe Exacerbations in COPD

BACKGROUND: Elevated levels of midrange proadrenomedullin (MR‐proADM) are associated with worse outcome in different diseases, including COPD. The association of stable‐state MR‐proADM with severe acute exacerbations of COPD (AECOPDs) requiring hospitalization, or with community‐acquired pneumonia (CAP) in patients with COPD, has not been studied yet. The aim of this study was to evaluate the association of stable‐state MR‐proADM with severe AECOPD and CAP in patients with COPD. METHODS: This study pooled data of 1,285 patients from the Cohort of Mortality and Inflammation in COPD (COMIC) and PRedicting Outcome using systemic Markers In Severe Exacerbations of Chronic Obstructive Pulmonary Disease (PROMISE‐COPD) cohort studies. Time until first severe AECOPD was compared between patients with high (≥ 0.87 nmol/L) or low (< 0.87 nmol/L) levels of plasma MR‐proADM in stable state as previously defined. For time until first CAP, only COMIC data (n = 795) were available. RESULTS: Patients with COPD with high‐level stable‐state MR‐proADM have a significantly higher risk for severe AECOPD compared with those with low‐level MR‐proADM with a corrected hazard ratio (HR) of 1.30 (95% CI, 1.01–1.68). Patients with high‐level stable‐state MR‐proADM had a significantly higher risk for CAP compared with patients with COPD with low‐level MR‐proADM in univariate analysis (HR, 1.93; 95% CI, 1.24–3.01), but after correction for age, lung function, and previous AECOPD, the association was no longer significant (corrected HR, 1.10; 95% CI, 0.68–1.80). CONCLUSIONS: Stable‐state high‐level MR‐proADM in patients with COPD is associated with severe AECOPD but not with CAP.

Original Research: COPDStable-State Midrange-Proadrenomedullin Level Is a Strong Predictor of Mortality in Patients With COPD

ABSTRACT BACKGROUND Midrange-proadrenomedullin (MR-proADM) has been shown to be elevated in patients hospitalized for an acute exacerbation of COPD (AECOPD) and in patients with community acquired pneumonia. MR-proADM when measured during AECOPD has also been shown to be a predictor for mortality, we hypothesized that MR-proADM levels measured in a stable state could also predict mortality. METHODS We included 181 patients in whom we had paired plasma samples for MR-proADM determinations during stable state and at hospitalization for AECOPD when they also produced sputum. Time to death or censoring was compared between patients with MR-proADM above or below the median of 0.71 nmol/L. The predictive value of MR-proADM for survival was determined by calculating the C statistic. RESULTS COPD patients with MR-proADM levels > 0.71 nmol/L in stable state had a 3-fold higher risk of dying than patients with MR-proADM levels < 0.71 nmol/L (HR 2.98 (95% CI 1.51-5.90); C statistic 0.76). The corrected Odds Ratio for one year mortality was 8.90 (95% CI 1.94 - 44.6) in patients with high MR-proADM levels measured in stable state, compared to patients with low levels. CONCLUSIONS MR-proADM measured in stable state showed to be a strong predictor for mortality in COPD patients. MR-proADM is far more convenient to measure than other predictors for mortality in COPD such as the BODE score.BACKGROUND Midrange-proadrenomedullin (MR-proADM) has been shown to be elevated in patients hospitalized for an acute exacerbation of COPD (AECOPD) and in patients with community-acquired pneumonia. When measured during AECOPDs, MR-proADM has also been shown to be a predictor of mortality. We hypothesized that MR-proADM levels measured in a stable state could also predict mortality. METHODS We included 181 patients in whom we had paired plasma samples for MR-proADM determinations during a stable state and at hospitalization for an AECOPD when they also produced sputum. Time to death or censoring was compared between patients with MR-proADM above or below the median of 0.71 nmol/L. The predictive value of MR-proADM for survival was determined by calculating the C statistic. RESULTS Patients with COPD and MR-proADM levels > 0.71 nmol/L in the stable state had a threefold-higher risk of dying than did patients with MR-proADM levels < 0.71 nmol/L (hazard ratio, 2.98 [95% CI, 1.51-5.90]; C statistic, 0.76). The corrected OR for 1-year mortality was 8.90 (95% CI, 1.94-44.6) in patients with high MR-proADM levels measured in the stable state, compared with patients with low levels measured in the stable state. CONCLUSIONS MR-proADM measured in the stable state appeared to be a strong predictor of mortality in patients with COPD. MR-proADM is far easier to measure than other predictors of mortality in COPD, such as BMI, airflow obstruction, dyspnea, and exercise capacity score.