AIM: (i) evaluate the performance of MR-pro-ADM in reflecting the outcome and 
risk for CAP patients in the emergency department, and (ii) compare the 
prognostic performance of MR-pro-ADM with that of clinical scores PSI and 
CURB65.
METHODS: Observational prospective, single-center study in patients with 
suspected community acquired pneumonia (CAP). Eighty one patients underwent full 
clinical and laboratory assessment as by protocol, and were followed up a 28 
days. Primary endpoints measured were: death, death at 14 days, non-invasive 
mechanical ventilation (NIMV), endotracheal intubation (EI), ICU admission, 
overall hospital stay >10 days, emergency department stay >4 days. The 
discriminative performance of MR-pro-ADM and clinical scores was assessed by 
AUROC analysis.
RESULTS: The distribution for MR-pro-ADM followed an upward trend, increasing 
with the increase of both PSI (p<0.001) and CURB65 (p<0.001) classes. However, 
the difference between MRproADM values and score classes was significant only in 
the case of CURB65 classes 0 and 1 (p = 0.046), 2 (p = 0.013), and 3 (p = 
0.011); and with PSI classes 5, 3 (p = 0.044), and 1 (p = 0.020). As to the 
differences among variables for the six end-points, MR-pro-ADM values in the two 
groups selected for each considered end-point differed in a statistically 
significant manner for all endpoints. Both PSI and CURB65 differed significantly 
for all end-points, except for stay in the ED longer than 4 days and the 
hospital stay longer than 10 days and endotracheal intubation (only PSI classes 
differed with statistical significance). ROC analyses evidenced that MR-pro-ADM 
values gave the greatest AUC for the prediction of death, endotracheal 
intubation, hospital stay >10 days and DE stay >4 days, compared to the PSI and 
CURB (though difference not statistically significant). For each endpoint 
measured, the best thresholds values for Mr-pro-ADM were: 1.6 (specificity 
76.5%; sensitivity 77.8%) for death; 2.5 (specificity 88.9%; sensitivity 80.0%) 
for death at 14 days; 1.5 (specificity 77.0%; sensitivity 87.5%) for NIMV; 2.4 
(specificity 88.7%; sensitivity 83.3%) for endotracheal intubation; 0.9 
(specificity 53.5%; sensitivity 70.6%) for DE stay greater than 4 days; 1.9 
(specificity 82.1%; sensitivity 55.3%) for hospital stay greater than 10 days. 
The AUC for the combination of MR-pro-ADM and PSI was 81.29% [63.41%-99.17%], 
but not in a statistically significant manner compared to the AUCs of the single 
predictors. Conversely, the AUC for the combination of MR-pro-ADM and CURB65 was 
87.58% [75.54%-99.62%], which was significantly greater than the AUC of CURB65 
(p = 0.047) or PSI (p = 0.017) alone.
CONCLUSIONS: The present study confirms that assessment of MR-pro-ADM levels in 
CAP patients in addition to CURB scores increases the prognostic accuracy of 
CURB alone and may help rule out discrepancies arising from flawed clinical 
severity classification. With particular reference to patients scoring in the 
upper classes of CURB and PSI, MR-pro-ADM values provided additional information 
towards a better risk stratification of those patients. In particular, our 
results pointed towards two MR-pro-ADM threshold values that appear to predict 
with a good degree of accuracy the patient's need for non-invasive mechanical 
ventilation, endotracheal intubation, or intensive care. This aspect, however, 
deserves further investigation.