• Darina Miteva Department of Pulmonology and Allergology, Medical University in Varna, Bulgaria
  • Yordan Radkov Department of Pulmonology and Allergology, Medical University in Varna, Bulgaria
  • Lilyia Ivanova Department of Microbiology and Virology, Medical University in Varna, Bulgaria
  • Trifon Chervenkov Department of Medical Genetics, Medical University in Varna, Bulgaria
  • Vanya Kostadinova Department of Pulmonology and Allergology, Medical University in Varna, Bulgaria
Keywords: MR-proADM, РСТ, CRP, CAP, prognosis


Introduction: Various biomarkers are used to evaluate the severity and prognosis of community acquired pneumonia (CAP).

Objectives: To study and compare the prognostic value of MR-proADM, РСТ and CRP in predicting the severity and outcome of CAP.

Methods: A prospective cohort study of 92 patients hospitalized with CAP in the Clinic of Pneumology and Phthisiatrics of MHAT “Saint Marina”–Varna in 2015 was conducted. The biomarkers were measured on admission. Midregional pro-adrenomedullin (MR-proADM) and procalcitonin (РСТ) were measured by standard ELISA, and C-reactive protein (CRP) was determined by latex-enhanced immunoturbidimetric assay. CAP severity was assessed by CURB-65.

Results: Patients were on average 59.2±16.8 years of age; 68.5% of them were male. The in-hospital mortality rate was 7.6%. The three biomarkers MR-proADM, РСТ and CRP were significantly higher in non-survivors compared to survivors (0.918±0.045 ng/ml vs. 0.397±0.269ng/ml, р<0.001; 2.14±0.60ng/ml vs. 1.12±0.68ng/ml, р<0.001 and 215.12±96.39 mg/L vs.175.74±221.5mg/L, p<0.05 respectively). In patients who needed intensive care, the biomarkers were also significantly higher than those in patients treated in the general hospital unit (0.509±0.336ng/ml vs. 0.414±0.28ng/ml, р<0.05; 1.92±0.76 ng/ml vs. 1.15±0.70ng/ml, p<0.05 and 221.98±100.34 mg/L vs. 165.31±122.84 mg/L, p<0.05 resp.). MR-proADM and РСТ showed a moderate correlation with the CURB-65 (r=0.33, p<0.01 and r=0.30, p<0.05 respectively). CRP did not correlate with the CURB-65 (r=0.10, p>0.05).

Conclusion: MR-proADM, РСТ and CRP were significantly higher in non-survivors and in patients treated in the intensive care unit. MR-proADM and РСТ showed a moderate correlation with the CURB-65, while the correlation coefficient for MR-proADM was higher. CRP did not correlate with the CURB-65.


Becker K.L, Snider R., Nylen E.S. (2010 Jan). Procalcitonin in sepsis and systemic inflammation: a harmful biomarker and a therapeutic target. Br J Pharmacol. 159(2): 253–264. doi: 10.1111/j.1476-5381.2009.00433.x

Bello S, Lasierra AB, Minchole E et al. (2012) Prognostic power of proadrenomedullin in community-acquired pneumonia is independent on etiology. Eur. Respir. J. 39: 1144-1155. DOI: 10.1183/09031936.00080411

Chalmers J,A. Singanayagam, A.Hill et al.(2008). C-Reactive Protein is an independent predictor of severity in community-acquired pneumonia, The American journal of medicine. 121, 219-225. doi: 10.1016/j.amjmed.2007.10.033.

Christ-Crain M, Morgenthaler NG, Stolz D et al. (2006). Pro-adrenomedullin to predict severity and outcome in community-acquired pneumonia Crit. Care. 10:96–103. doi: 10.1186/cc4955

Christ-Crain M, Stolz D, Bingisser R et al.(2006). Procalcitonin guidance of antibiotic therapy in community-acquired pneumonia: a randomized trial. Am. J. Respir. Crit. Care Med. 174, 84–93. DOI:10.1164/rccm.200512-1922OC

Clyne B, J.Olshaker (1999). The C-reactive protein. J. Emergency Med.17(6): 1019–1025.

Huang DT, Angus DC, Kellum JA, Pugh NA,et al.(2009 Sep). Midregional proadrenomedullin as a prognostic tool in community-acquired pneumonia. Chest. 136(3):823-31. doi: 10.1378/chest.08-1981

Kitamura K, Kangawa K, Kawamoto M,et al. (1993 Apr). Adrenomedullin: a novel hypotensive peptide isolated from human pheochromocytoma. Biochem Biophys Res Commun. 30;192(2):553-60. DOI:10.1006/bbrc.1993.1451

Krüger S, Ewig S, Kunde J et al.(2010). Assessment of inflammatory markers in patients with community-acquired pneumonia – influence of antimicrobial pre-treatment. Results from the German competence network CAPNETZ.Clin.Chim.Acta. 411, 1929–1934. DOI: 10.1016/j.cca.2010.08.004

Krüger S, Ewig S, Marre R et al.(2008 Feb) Procalcitonin predicts patients at low risk of death from community-acquired pneumonia. Eur. Respir. J. 31(2), 349–355. DOI:10.1183/09031936.00054507

Lacoma A, Bas A, Tudela P, (2014). Correlation of inflammatory and cardiovascular biomarkers with pneumonia severity scores. Enfermedades Infecciosas y Microbiología Clínica. 32 (3), 140–146.

Meisner M. (2000). Procalcitonin (PCT) – a new, innovative infection parameter. Biochemical and clinical aspects. New York: Thieme Stuttgart ISBN 3-13-105503-0.

Menéndez R, Martínez R, Reyes S et al. (2009). Biomarkers improve mortality prediction by prognostic scales in community-acquired pneumonia. Thorax. 64, 587–591. doi: 10.1136/thx.2008.105312

Morgenthaler NG, Struck J, Alonso C, Bergmann A. (2005 Oct). Measurement of Midregional Proadrenomedullin in Plasma with an Immunoluminometric Assay. Clinical Chemistry. 51 (10) ;1823-1829. DOI: 10.1373/clinchem.2005.051110

Ramírez P, Ferrer M, Martí V et al. (2011). Inflammatory biomarkers and prediction for intensive care unit admission in severe community-acquired pneumonia. Crit. Care Med. 39, 2211–2217. doi: 10.1097/CCM.0b013e3182257445.

Renaud B, Schuetz P, Claessens YE, et al.(2012 Dec). Proadrenomedullin improves risk of early admission to ICU score for predicting early severe community-acquired pneumonia. Chest.142(6):1447–54.

Suberviola B, Castellanos-Ortega A, Llorca J et al. (2012 Mar). Prognostic value of proadrenomedullin in severe sepsis and septic shock patients with community-acquired pneumonia. Swiss Med Wkly. 19;142:w13542. doi: 10.4414/smw.2012.13542.

Ueda S, Nishio K, Minamino N, Kubo A, Akai Y, Kangawa et al. (1999). Increased plasma levels of adrenomedullin in patients with systemic inflammatory response syndrome. Am J Respir Crit Care Med. 160:132–136. DOI:10.1164/ajrccm.160.1.9810006