Single-center prospective cohort study.
SETTING: Tertiary care, academic, university hospital.
PATIENTS: None.
MEASUREMENTS AND MAIN RESULTS: Blood samples were withdrawn on the day of
fever onset and 4 to 7 days thereafter, and the serum
proadrenomedullin,
procalcitonin, and
C-reactive protein levels were measured using the Kryptor technology afterward. Of the 114 adult patients, 27 had
bloodstream infections, 36 had localized
infections, and the remaining had no
infections. The area under the receiver operating characteristic curve for
bloodstream infection diagnosis was significantly greater for
proadrenomedullin (0.70; 95% CI, 0.59-0.82) and
procalcitonin (0.71; 95% CI, 0.60-0.83) compared with
C-reactive protein (0.53; 95% CI, 0.39-0.66) (p = 0.021 and p = 0.003, respectively). Receiver operating characteristic analysis also showed that
proadrenomedullin (p = 0.005) and
procalcitonin (p = 0.009) each had a better performance than
C-reactive protein in predicting patients' mortality within 2 months after their
fever onset. Regarding patients' response to antimicrobial
therapy,
proadrenomedullin,
procalcitonin, and
C-reactive protein levels all significantly decreased from baseline to follow-up in responders (p ≤ 0.002), whereas only
proadrenomedullin level significantly increased in nonresponders (p < 0.0001). In patients with documented
infections,
proadrenomedullin (0.81; 95% CI, 0.71-0.92) and
procalcitonin (0.73; 95% CI, 0.60-0.85) each had a greater area under the curve compared with
C-reactive protein (0.59; 95% CI, 0.45-0.73) as for as predicting response (p = 0.004 and p = 0.043, respectively). However, for all febrile patients,
proadrenomedullin had a significantly greater area under the curve for predicting favorable response than
procalcitonin (p < 0.0001).
CONCLUSION: