Letter to the Editor
Usefulness of Biomarkers as Prognostic Factors of Mortality in Elderly Patients with Community-acquired Pneumonia
Utilidad de los biomarcadores como factores pronósticos de mortalidad en los pacientes ancianos con neumonía adquirida en la comunidad
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The authors conclude their article by saying that age and other clinical, laboratory and geriatric assessment parameters, such as functional capacity, are useful for predicting mortality in the short term.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We have few points we would like to add to this report. In the last 10 years, the incidence of CAP seen in emergency departments in Spain has increased from 0.85% to 1.35% (<span class="elsevierStyleItalic">P</span><.001).<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In total, 51% of CAPs were recorded in patients aged 70 years and older, and clinical presentation and mortality were significantly worse in this population than in patients aged 15–69 years (<span class="elsevierStyleItalic">P</span><.001).<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> These data have generated a growing awareness of the need for an accurate prognosis of mortality in elderly patients. Some biomarkers have proven useful as independent predictors of mortality in CAP patients,<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> but reports of varying results in elderly individuals and other adults<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> have raised questions about the usefulness of these biomarkers in patients of different ages.</p><p id="par0015" class="elsevierStylePara elsevierViewall">These results motivated our group to retrospectively analyze the databases of some our studies<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> in order to determine diagnostic factors for predicting mortality in the short term among CAP patients aged 75 years or older, or younger than 75, who were admitted to our hospital between November 2011 and July 2012. A total of 146 patients were included. Two subgroups were formed: group A (15–74 years: 79 cases, 54.1%) and group B (≥75 years: 67 cases, 45.9%). Some results are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. Despite the limitations of a small sample size and the retrospective, single-center nature of the analysis, we found mid-regional proadrenomedullin (MR-proADM) to be the most useful biomarker for predicting short-term mortality (intra-hospital and up to 30 days post-admission) in both group A and group B, and the one with the largest area under the receiver operating curve (AUC–ROC). Similarly, albeit to a lesser extent, procalcitonin levels significantly predicted differences in survival in both age groups and differences in mean numbers of survivors and non-survivors. No significant differences were observed between mean concentrations of C-reactive protein (non-survivors vs survivors) and the AUC–ROC curves are of little use, particularly in group B.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">While awaiting the findings of a prospective study specifically designed to determine the utility of procalcitonin and, more importantly, MR-proADM for predicting mortality in elderly patients, initial determinations of these biomarkers in emergency departments could orient the prognosis of elderly patients with CAP. These patients often have a more deceptive and unclear clinical presentation, limited functional status and a high comorbidity burden. Although the role, utility and effectiveness of each biomarker will have to be defined, we believe they will be of use in determining the prognosis and care of elderly patients with CAP, and for making decisions on admission and the most appropriate destination of these fragile individuals.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interests</span><p id="par0025" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interests" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Please cite this article as: Julián-Jiménez A, Rodríguez EV, Magdaleno RES, Martín BC. Utilidad de los biomarcadores como factores pronósticos de mortalidad en los pacientes ancianos con neumonía adquirida en la comunidad. Arch Bronconeumol. 2016;52:110–111.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Group A: 79 patients aged 15–74 years.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Group B: 67 patients ≥75 years.</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">CI, confidence interval; CRP, C-reactive protein; MR-proADM, mid-regional proadrenomedullin; PCT, procalcitonin; ROC-AUC, receiver operating characteristic–area under the curve; SD, standard deviation.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Concentrations in Group AMean±SD<span class="elsevierStyleItalic">P</span>-value<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a></th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Concentrations in Group BMean±SD<span class="elsevierStyleItalic">P</span>-value<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a></th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">30-day mortality after admissionROC–AUC (95% CI)<span class="elsevierStyleItalic">P</span>-value<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a></th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Survived (75) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Died (4) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Survived (58) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Died (9) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Group A \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Group B \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">MR-proADM (nmol/l)</td><td class="td" title="table-entry " align="left" valign="top">1.18±0.88 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">461±3.66 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.57±0.94 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5.09±4.58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.909 (0.806–1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.858 (0.722–0.993) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">P</span>=.006</td><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">P</span>=.001</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">P</span>=.006 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">P</span>=.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">PCT (ng/ml)</td><td class="td" title="table-entry " align="left" valign="top">3.06±1.33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6.48±19.80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.75±1.64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6.13±5.75 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.794 (0.697–0.891) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.790 (0.581–1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">P</span>=.047 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">P</span>=.005 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">P</span>=.049 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">P</span>=.005 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">CRP (mg/l)</td><td class="td" title="table-entry " align="left" valign="top">76.32±45.20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">101.50±43.30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">82.89±46.15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">95±41.82 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.706 (0.449–0.964) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.606 (0.391–0.822) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">P</span>=.177</td><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">P</span>=.296</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">P</span>=.167 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">P</span>=.309 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab982782.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Comparison of means between groups 2×2 (Student's <span class="elsevierStyleItalic">t</span> test and Mann–Whitney <span class="elsevierStyleItalic">U</span> test), as applicable.</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "<p 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 1 | 1 | 2 |
| 2024 October | 37 | 16 | 53 |
| 2024 September | 40 | 12 | 52 |
| 2024 August | 58 | 36 | 94 |
| 2024 July | 51 | 21 | 72 |
| 2024 June | 76 | 23 | 99 |
| 2024 May | 80 | 24 | 104 |
| 2024 April | 33 | 25 | 58 |
| 2024 March | 38 | 18 | 56 |
| 2024 February | 33 | 18 | 51 |
| 2023 March | 6 | 4 | 10 |
| 2023 February | 28 | 16 | 44 |
| 2023 January | 19 | 36 | 55 |
| 2022 December | 33 | 42 | 75 |
| 2022 November | 32 | 23 | 55 |
| 2022 October | 40 | 37 | 77 |
| 2022 September | 23 | 26 | 49 |
| 2022 August | 24 | 41 | 65 |
| 2022 July | 29 | 47 | 76 |
| 2022 June | 23 | 34 | 57 |
| 2022 May | 35 | 31 | 66 |
| 2022 April | 20 | 33 | 53 |
| 2022 March | 26 | 38 | 64 |
| 2022 February | 41 | 36 | 77 |
| 2022 January | 35 | 31 | 66 |
| 2021 December | 30 | 33 | 63 |
| 2021 November | 25 | 41 | 66 |
| 2021 October | 29 | 37 | 66 |
| 2021 September | 35 | 42 | 77 |
| 2021 August | 34 | 31 | 65 |
| 2021 July | 15 | 22 | 37 |
| 2021 June | 38 | 30 | 68 |
| 2021 May | 34 | 29 | 63 |
| 2021 April | 60 | 76 | 136 |
| 2021 March | 43 | 26 | 69 |
| 2021 February | 25 | 20 | 45 |
| 2021 January | 30 | 12 | 42 |
| 2020 December | 20 | 15 | 35 |
| 2020 November | 17 | 19 | 36 |
| 2020 October | 29 | 10 | 39 |
| 2020 September | 26 | 13 | 39 |
| 2020 August | 20 | 16 | 36 |
| 2020 July | 26 | 26 | 52 |
| 2020 June | 27 | 17 | 44 |
| 2020 May | 44 | 16 | 60 |
| 2020 April | 44 | 18 | 62 |
| 2020 March | 33 | 28 | 61 |
| 2020 February | 36 | 23 | 59 |
| 2020 January | 51 | 28 | 79 |
| 2019 December | 42 | 25 | 67 |
| 2019 November | 46 | 27 | 73 |
| 2019 October | 15 | 6 | 21 |
| 2019 September | 15 | 5 | 20 |
| 2019 August | 21 | 14 | 35 |
| 2019 July | 18 | 12 | 30 |
| 2019 June | 12 | 8 | 20 |
| 2019 May | 20 | 17 | 37 |
| 2019 April | 24 | 32 | 56 |
| 2019 March | 34 | 22 | 56 |
| 2019 February | 32 | 15 | 47 |
| 2019 January | 21 | 17 | 38 |
| 2018 December | 15 | 7 | 22 |
| 2018 November | 43 | 13 | 56 |
| 2018 October | 45 | 16 | 61 |
| 2018 September | 18 | 6 | 24 |
| 2018 August | 1 | 0 | 1 |
| 2018 July | 1 | 0 | 1 |
| 2018 May | 17 | 1 | 18 |
| 2018 April | 22 | 3 | 25 |
| 2018 March | 21 | 5 | 26 |
| 2018 February | 22 | 4 | 26 |
| 2018 January | 72 | 7 | 79 |
| 2017 December | 92 | 5 | 97 |
| 2017 November | 35 | 6 | 41 |
| 2017 October | 13 | 6 | 19 |
| 2017 September | 22 | 15 | 37 |
| 2017 August | 15 | 7 | 22 |
| 2017 July | 17 | 7 | 24 |
| 2017 June | 34 | 10 | 44 |
| 2017 May | 31 | 10 | 41 |
| 2017 April | 29 | 8 | 37 |
| 2017 March | 16 | 3 | 19 |
| 2017 February | 11 | 4 | 15 |
| 2017 January | 8 | 10 | 18 |
| 2016 December | 28 | 5 | 33 |
| 2016 November | 36 | 9 | 45 |
| 2016 October | 38 | 15 | 53 |
| 2016 September | 29 | 11 | 40 |
| 2016 August | 37 | 12 | 49 |
| 2016 July | 28 | 12 | 40 |
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