Soluble thrombomodulin to evaluate the severity and outcome of community-acquired pneumonia

This study aims to investigate the role of soluble thrombomodulin (sTM) in the evaluation of the severity and outcome of community-acquired pneumonia (CAP) in the emergency department (ED) and compare sTM with two biomarkers-procalcitonin (PCT) and C-reactive protein (CRP)-and two scoring systems-the Pneumonia Severity Index (PSI) and CURB65 score. Patients with CAP were consecutively enrolled in the ED of an urban university hospital. sTM, PCT, and CRP levels were measured on enrollment. In addition, the PSI and CURB65 scores were calculated. For all patients, a 30-day follow-up was performed. A total of 573 patients with CAP were enrolled in this study. sTM, PCT, and CRP levels increased with the aggravation of the disease severity as assessed by the PSI and CURB65 score (all P <0.01). The multivariate logistic regression analysis showed that sTM and the PSI were independent predictors of 30-day mortality, and the receiver operating characteristic curve analysis showed that the accuracy of sTM in the prediction of 30-day mortality was comparable with the PSI (P >0.05) and better than PCT, CRP, and the CURB65 score (P all <0.05). Furthermore, a combination of sTM and scoring systems can enhance the predictive accuracy of 30-day mortality. sTM is useful in the evaluation of the severity and outcome of CAP in the ED. A well-designed, multi-center study will be needed to further investigate the value of sTM in CAP.