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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...
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| Zeitschriftentitel: | BMJ Open |
|---|---|
| Personen und Körperschaften: | , , , , , , |
| In: | BMJ Open, 8, 2018, 11, S. e020337 |
| Format: | E-Article |
| Sprache: | Englisch |
| veröffentlicht: |
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| Schlagwörter: |
| author_facet |
Graziadio, Sara O’Leary, Rachel Amie Stocken, Deborah D Power, Michael Allen, A Joy Simpson, A John Price, David Ashley Graziadio, Sara O’Leary, Rachel Amie Stocken, Deborah D Power, Michael Allen, A Joy Simpson, A John Price, David Ashley |
|---|---|
| author |
Graziadio, Sara O’Leary, Rachel Amie Stocken, Deborah D Power, Michael Allen, A Joy Simpson, A John Price, David Ashley |
| spellingShingle |
Graziadio, Sara O’Leary, Rachel Amie Stocken, Deborah D Power, Michael Allen, A Joy Simpson, A John Price, David Ashley BMJ Open 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 General Medicine |
| author_sort |
graziadio, sara |
| spelling |
Graziadio, Sara O’Leary, Rachel Amie Stocken, Deborah D Power, Michael Allen, A Joy Simpson, A John Price, David Ashley 2044-6055 2044-6055 BMJ General Medicine http://dx.doi.org/10.1136/bmjopen-2017-020337 <jats:sec><jats:title>Objective</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Prospective observational study.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>The Medical Admissions Suite of the Royal Victoria Infirmary, Newcastle.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Outcome measure</jats:title><jats:p>The primary outcome measure was the proportion of patients who, within 72 hours, had an<jats:italic>acuity increase</jats:italic>, 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.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>NEWS and MR-proADM together predicted<jats:italic>acuity increase</jats:italic>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).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>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.</jats:p></jats:sec> 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 |
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| title |
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 |
| title_unstemmed |
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 |
| title_full |
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 |
| title_fullStr |
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 |
| title_full_unstemmed |
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 |
| title_short |
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 |
| title_sort |
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 |
| topic |
General Medicine |
| url |
http://dx.doi.org/10.1136/bmjopen-2017-020337 |
| publishDate |
2018 |
| physical |
e020337 |
| description |
<jats:sec><jats:title>Objective</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Prospective observational study.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>The Medical Admissions Suite of the Royal Victoria Infirmary, Newcastle.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Outcome measure</jats:title><jats:p>The primary outcome measure was the proportion of patients who, within 72 hours, had an<jats:italic>acuity increase</jats:italic>, 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.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>NEWS and MR-proADM together predicted<jats:italic>acuity increase</jats:italic>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).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>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.</jats:p></jats:sec> |
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| author | Graziadio, Sara, O’Leary, Rachel Amie, Stocken, Deborah D, Power, Michael, Allen, A Joy, Simpson, A John, Price, David Ashley |
| author_facet | Graziadio, Sara, O’Leary, Rachel Amie, Stocken, Deborah D, Power, Michael, Allen, A Joy, Simpson, A John, Price, David Ashley, Graziadio, Sara, O’Leary, Rachel Amie, Stocken, Deborah D, Power, Michael, Allen, A Joy, Simpson, A John, Price, David Ashley |
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| description | <jats:sec><jats:title>Objective</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Prospective observational study.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>The Medical Admissions Suite of the Royal Victoria Infirmary, Newcastle.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Outcome measure</jats:title><jats:p>The primary outcome measure was the proportion of patients who, within 72 hours, had an<jats:italic>acuity increase</jats:italic>, 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.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>NEWS and MR-proADM together predicted<jats:italic>acuity increase</jats:italic>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).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>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.</jats:p></jats:sec> |
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| spelling | Graziadio, Sara O’Leary, Rachel Amie Stocken, Deborah D Power, Michael Allen, A Joy Simpson, A John Price, David Ashley 2044-6055 2044-6055 BMJ General Medicine http://dx.doi.org/10.1136/bmjopen-2017-020337 <jats:sec><jats:title>Objective</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Prospective observational study.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>The Medical Admissions Suite of the Royal Victoria Infirmary, Newcastle.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>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.</jats:p></jats:sec><jats:sec><jats:title>Outcome measure</jats:title><jats:p>The primary outcome measure was the proportion of patients who, within 72 hours, had an<jats:italic>acuity increase</jats:italic>, 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.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>NEWS and MR-proADM together predicted<jats:italic>acuity increase</jats:italic>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).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>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.</jats:p></jats:sec> 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 |
| spellingShingle | Graziadio, Sara, O’Leary, Rachel Amie, Stocken, Deborah D, Power, Michael, Allen, A Joy, Simpson, A John, Price, David Ashley, BMJ Open, 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, General Medicine |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| title_unstemmed | 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 |
| topic | General Medicine |
| url | http://dx.doi.org/10.1136/bmjopen-2017-020337 |