Valor pronóstico de la proadrenomedulina y el NT-proBNP en los pacientes procedentes de urgencias con síndrome gripal / Prognostic value of pro-adrenomedullin and NT-proBNP in patients referred from the emergency department with influenza syndrome

RESUMEN

Objetivos: Analizar el valor pronóstico de la procalcitonina (PCT), la proteína C reactiva (PCR), el NT-proBNP y la región medial de la proadrenomedulina (MR-proADM) en pacientes hospitalizados con síndrome gripal. Método: Estudio prospectivo realizado en pacientes hospitalizados desde urgencias por síndrome gripal. Se analizaron las concentraciones de biomarcadores en las primeras 24 h de ingreso y el test de gripe y se analizó su capacidad predictiva de mal pronóstico: estancia superior a 7 días, ingreso en unidad de cuidados intensivos o fallecimiento intrahospitalario. Resultados: Se incluyeron 98 pacientes, 44 (44,9%) de ellos con mal pronóstico. Las áreas bajo la curva COR para mal pronóstico fueron de 0,68 (IC 95% 0,56-0,80) para NT-proBNP y de 0,73 (IC 95% 0,62-0,84) para la MRproADM, y no significativas para PCT y PCR. Las variables asociadas independientemente con mal pronóstico fueron: neumonía (OR 7,46 [IC 95% 2,08-26,73]; p = 0,002), insuficiencia cardiaca (OR 5,16 [IC 95% 1,35-19,74]; p = 0,016) y NT-proBNP > 580 pg/ml (OR 4,68 [IC 95% 1,53-14,26]; p = 0,006). En los 53 pacientes con gripe A(H1N1) confirmada, solo el NT-proBNP tuvo un valor pronóstico independiente (OR ajustado 5,75 [IC 95% 1,46-22,61]; p = 0,012). Conclusiones: En pacientes con síndrome gripal, el NT-proBNP y la MR-proADM fueron los únicos biomarcadores con valor pronóstico, y solo el primero de ellos mantuvo esta asociación en pacientes con gripe confirmada

ABSTRACT

Objectives: To assess the prognostic value of procalcitonin (PTC), C-reactive protein (CRP), N-terminal prohormone of brain natriuretic peptide (NT-proBNP), and mid-regional pro-adrenomedullin (MR-proADM) in patients with influenza syndrome. Methods: Prospective study in patients admitted from the emergency department with influenza syndrome. Biomarker concentrations were measured in the first 24 h after admission and a test for influenza. The results were analyzed for ability to predict a hospital stay longer than 7 days, intensive care unit admission, or in-hospital death. Results: Ninety-eight patients were included; the prognosis of 44 (44.9%) was classified as poor. The areas under the receiving operator characteristic curve were 0.68 (95% CI, 0.56-0.80) for NT-proBNP, 0.73 (95% CI, 0.62-0.84) for MR-proADM, and nonsignificant for PCT and CRP. The following variables were independently associated with a poor prognosis: pneumonia (OR, 7.46 [95% CI, 2.08-26.73]; P=.002), heart failure (OR, 5.16 [95% CI, 1.35-19.74]; P=.016), and NT-proBNP > 580 pg/mL (OR, 4.68 [95% CI, 1.53-14.26]; P=.006). In the 53 patients with confirmed A(H1N1) influenza, only NT-proBNP was an independent predictor of prognosis (adjusted OR, 5.75 [95% CI, 1.4622.61]; P=.012). Conclusions: NT-proBNP and MR-proADM were the only biomarkers with prognostic value. Only NT-proBNP was a useful predictor in patients with confirmed influenza