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Midregional proadrenomedullin safely reduces hospitalization in a low severity cohort with infections in the ED: a
Juan Gonzalez Del Castillo1, Carlota Clemente-Callejo2, Ferran Llopis3
1Emergency Department, Instituto de Investigación Sanitaria (IdISSC), Hospital Clínico San Carlos, Madrid, Spain.
Introduction:
The midregional fragment of proadrenomedullin (MR-proADM) is known to provide accurate short-, mid- and long term prognostic information in the triage and multi-dimensional risk assessment of patients in the emergency department (ED). In two independent observational cohorts MR-proADM values identified low disease severity patients without risk of disease progression in the ED with no 28 days mortality that wouldn´t require hospitalization. In this interventional study we want to show that the combination of an MR-proADM algorithm with clinical assessment is able to identify low risk patients not requiring hospitalization to safely reduce the number of hospital admissions.
Methods:
A randomized-controlled interventional multicenter study in 4 EDs in Spain. The study protocol was approved by Ethics Committees. Control arm patients received Standard Care. MR-proADM guided arm patients with low MR-proADM value (≤0.87 nmol/L) were treated as out-patients, with high MR-proADM value (>0.87 nmol/L) were hospitalized. The hospitalization rate was compared between the study arms.
Results:
Two hundred patients with suspicion of infection were enrolled. In the MR-proADM guided arm the hospital admission rate in the intention-to-treat (ITT) population was 17% lower than in the control arm (40.6% vs. 57.6%, p=0.024) and 20% lower in the per protocol (PP) population (37.2% vs. 57.6%, p=0.009). No deaths of out-patients and no significant difference for the safety endpoints readmission and representation rates were observed. The readmission rate was only slightly higher in the MR-proADM guided arm compared to the control arm (PP population: at 14 days 9.3% vs. 7.1%, difference 2.1% (95% CI: -11.0% to 15.2%); and at 28 days 11.1% vs. 9.5%, difference 1.6% (95% CI: -12.2% to 15.4%)). The rate of 28 days representation was slightly lower in the MR-proADM guided arm compared to the control arm (20.4% vs. 26.2%, difference -5.8% (95% CI: -25.0% to 13.4%); PP population).
Conclusions:
Implementing a MR-proADM algorithm optimizes ED workflows efficiently and sustainably. Hospitals can highly benefit from a reduced rate of hospitalizations by 20% using MR-proADM. The safety in the MR-proADM guided study arm was similar to the Standard Care arm.
Trial Registration:
ClinicalTrials.gov Identifier NCT03770533.
Insights
The midregional proadrenomedullin (MR-proADM) algorithm safely reduced hospital admissions by 20% in patients with suspected infections. This approach optimizes emergency department workflows without compromising patient safety or increasing readmissions.
Area of Science:
- Biomarkers in Emergency Medicine
- Clinical Risk Assessment
- Health Services Research
Background:
- Midregional proadrenomedullin (MR-proADM) offers prognostic insights for emergency department (ED) patients.
- MR-proADM identifies low-risk individuals who may not require hospitalization.
- This study investigates an interventional approach using MR-proADM to reduce hospital admissions.
Purpose of the Study:
- To evaluate if an MR-proADM algorithm combined with clinical assessment can safely decrease hospital admissions in the ED.
- To compare hospitalization rates between standard care and MR-proADM-guided management.
Main Methods:
- A randomized-controlled, multicenter interventional study conducted in 4 Spanish EDs.
- Patients were randomized to standard care or MR-proADM-guided management (hospitalization if MR-proADM >0.87 nmol/L).
- The primary endpoint was the hospitalization rate.
Main Results:
- The MR-proADM guided arm showed a 17% lower hospitalization rate in the ITT population (40.6% vs. 57.6%) and 20% in the PP population (37.2% vs. 57.6%).
- No out-patient deaths occurred, and safety endpoints (readmission, representation) were similar to the control arm.
- The MR-proADM algorithm demonstrated efficient workflow optimization and sustainability.
Conclusions:
- Implementing an MR-proADM algorithm can significantly reduce hospital admission rates in the ED by up to 20%.
- This strategy optimizes ED workflows efficiently and sustainably.
- The MR-proADM-guided approach is safe, with comparable outcomes to standard care.
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