Prognostic value of serum pregnancy-associated plasma protein A level at the initial ED presentation in elderly patients with CAP
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2015
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Abstract
Objective This study aims to compare serum pregnancy-associated plasma protein A (PAPP-A) levels in surviving and nonsurviving elderly patients with community-acquired pneumonia (CAP), investigating whether PAPP-A is correlated with CAP prediction scores and whether PAPP-A can successfully predict 28-day mortality rates in elderly patients. Methods This prospective, observational, single-center, cross-sectional study was conducted at the emergency department (ED) of Celal Bayar University Hospital in Manisa, Turkey, between January and September 2014. All patients underwent follow-up evaluations 28 days after admission. The end point was defined as all-cause mortality. Results A total of 100 elderly patients (mean age, 77.3 ± 7.6 years [range, 65-94 years]); 60% men) with CAP were enrolled in this study. All-cause mortality at the 28-day follow-up evaluation was 22%. Admission PAPP-A levels were significantly higher in nonsurvivors compared with 28-day survivors (10.3 ± 4.5 vs 3.8 ± 2.6 ng/mL, P <.001). A significant and positive correlation between admission PAPP-A levels and pneumonia severity index; confusion, oxygen saturation, respiratory rate, blood pressure, and age 75 years or older; and confusion, urea, respiratory rate, blood pressure, and age older than 65 years scores was found (r =.440, P <.001; r =.395, P <.001; and r =.359, P <.001, respectively). Moreover, we determined that the optimal PAPP-A cutoff for predicting 28-day mortality at the time of ED admission was 5.1 ng/mL, with 77.3% sensitivity and 77.9% specificity. Conclusions Serum PAPP-A level is valuable for predicting mortality and the severity of the disease among elderly patients with CAP at ED admission. Thus, PAPP-A might play a further role in the clinical assessment of the severity of CAP. © 2015 Elsevier Inc.
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Age Factors , Aged , Aged, 80 and over , Community-Acquired Infections , Cross-Sectional Studies , Emergency Service, Hospital , Female , Humans , Male , Pneumonia , Predictive Value of Tests , Pregnancy-Associated Plasma Protein-A , Prognosis , Prospective Studies , Risk Factors , ROC Curve , Survival Rate , creatinine , pregnancy associated plasma protein A , urea , pregnancy associated plasma protein A , age , aged , Article , blood pressure , breathing rate , chronic lung disease , community acquired pneumonia , comorbidity , confusion , creatinine blood level , cross-sectional study , emergency ward , female , follow up , geriatric disorder , geriatric patient , heart disease , human , lung ventilation , major clinical study , male , malignant neoplastic disease , observational study , oxygen saturation , Pneumonia Severity Index , priority journal , prognosis , prospective study , protein blood level , survival time , survivor , thrombocyte volume , urea blood level , urea nitrogen blood level , blood , Community-Acquired Infections , emergency health service , metabolism , mortality , pneumonia , predictive value , prognosis , receiver operating characteristic , risk factor , survival rate , very elderly