Adrenomedullin optimises mortality prediction in COPD patients

Marjolein Brusse-Keizere， Maaike Zuur-Telgen， Job van der Palen， Paul VanderValk， Huib Kerstjens， Wim Boersma， Francesco Blasi， Konstantinos Kostikas， Branislava Milenkovic， Michael Tamm， Daiana Stolz

Background

Current multicomponent scores that predict mortality in COPD patients might underestimate the systemic component of COPD. Therefore, we evaluated the accuracy of circulating levels of proadrenomedullin (MR-proADM) alone or combined with the ADO (Age, Dyspnoea, airflow Obstruction), updated ADO or BOD (Body mass index, airflow Obstruction, Dyspnoea) index to predict all-cause mortality in stable COPD patients.

Methods

This study pooled data of 1285 patients from the COMIC and PROMISE-COPD study.

Results

Patients with high MR-proADM levels (≥0.87 nmol/l) had a 2.1 fold higher risk of dying than those with lower levels (p < 0.001). Based on the C-statistic, the ADOA index (ADO plus MR-proADM) (C = 0.72) was the most accurate predictor followed by the BODA (BOD plus MR-proADM) (C = 0.71) and the updated ADOA index (updated ADO plus MR-proADM) (C = 0.70). Adding MR-proADM to ADO and BOD was superior in forecasting 1- and 2-year mortality. The net percentages of persons with events correctly reclassified (NRI+) within respectively 1-year and 2-year was 31% and 20% for ADO, 31% and 20% for updated ADO and 25% and 19% for BOD. The net percentages of persons without events correctly reclassified (NRI-) within respectively 1-year and 2-year was 26% and 27% for ADO, 27% and 28% for updated ADO and 34% and 34% for BOD.

Conclusions

Adding MR-proADM increased the predictive power of BOD, ADO and updated ADO index.

respiratory medicine

June 2015Volume 109, Issue 6, Pages 734–742

DOI: http://dx.doi.org/10.1016/j.rmed.2015.02.013 |