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Vol. 148. Issue 11.
Pages 501-510 (June 2017)
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Vol. 148. Issue 11.
Pages 501-510 (June 2017)
Review
DOI: 10.1016/j.medcle.2017.04.033
Usefulness and prognostic value of biomarkers in patients with community-acquired pneumonia in the emergency department
Utilidad y valor pronóstico de los biomarcadores en los pacientes con neumonía adquirida en la comunidad en los servicios de urgencias
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Agustín Julián-Jiméneza,
Corresponding author
agustinj@sescam.jccm.es

Corresponding author.
, Juan González del Castillob, Francisco Javier Candelc
a Servicio de Urgencias, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
b Servicio de Urgencias, Hospital Universitario Clínico San Carlos, Madrid, Spain
c Servicio de Microbiología Clínica, Hospital Clínico Universitario San Carlos, Madrid, Spain
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Table 1. Studies evaluating mid-regional proadrenomedullin in emergency department patients as a prognostic factor in community-acquired pneumonia.
Table 2. Practical recommendations for the use of biomarkers in patients with community-acquired pneumonia in emergency departments.
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Abstract

Between all patients treated in the Emergency Department (ED), 1.35% are diagnosed with community-acquired pneumonia (CAP). CAP is the main cause of death due to infectious disease (10–14%) and the most frequent reason of sepsis-septic shock in the ED. In the last decade, the search for objective tools to help establishing an early diagnosis, bacterial aetiology, severity, suspicion of bacteremia and the prognosis of mortality has increased. Biomarkers have shown their usefulness in this matter. Procalcitonin (obtains the highest accuracy for CAP diagnosis, bacterial aetiology and the presence of bacteremia), lactate (biomarker of hypoxia and tissue hypoperfusion) and proadrenomedullin (which has the greatest accuracy to predict mortality which in combination with the prognostic severity scales obtains even better results).

The aim of this review is to highlight recently published scientific evidence and to compare the utility and prognostic accuracy of the biomarkers in CAP patients treated in the ED.

Keywords:
Biomarkers
Bacteraemia
Community-acquired pneumonia
C-reactive protein
Emergency department
Lactate
Mortality
Proadrenomedullin
Procalcitonin
Prognosis
Resumen

Al 1,35% de los pacientes del servicio de urgencias (SU) se les diagnostica neumonía adquirida en la comunidad (NAC), principal causa infecciosa de muerte en nuestro entorno (10-14%) y origen de la mayoría de sepsis-shock sépticos en los SU. En la última década se ha acentuado la búsqueda de herramientas de ayuda para establecer un diagnóstico precoz, la etiología, la gravedad, la sospecha de bacteriemia y el pronóstico de mortalidad en la NAC. Para ello los biomarcadores han demostrado gran utilidad: procalcitonina (mayor rendimiento diagnóstico de NAC, etiología bacteriana y coexistencia de bacteriemia), lactato (marcador de hipoxia e hipoperfusión tisular) y proadrenomedulina (con la mayor capacidad de predecir mortalidad y combinada con las escalas pronósticas de gravedad obtiene aún mejores resultados). Esta revisión quiere poner de manifiesto las evidencias científicas recientes, aclarar las controversias existentes y comparar la utilidad y capacidad pronóstica de los biomarcadores en los pacientes con NAC en los SU.

Palabras clave:
Servicio de urgencias
Neumonía adquirida en la comunidad
Pronóstico
Mortalidad
Biomarcadores
Procalcitonina
Proadrenomedulina
Proteína C reactiva
Lactato
Bacteriemia

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