• Francesco Travaglino, Veronica Russo, Benedetta De Berardinis, Filippo Numeroso, Pamela Catania, Gianfranco Cervellin, Stefano Geniere Nigra, Francesco Geraci, Maria Antonietta Bressan, Stefania Guerrini, Mario Cavazza, Christian Folli, Valter Monzani, Stefania Battista, Giulio Mengozzi, Paola Noto, Giuseppe Carpinteri, Andrea Semplicini, Federica Stella, Stella Ingrassia, Paolo Moscatelli, Patrizia Giuntini, Gerardo Salerno, Patrizia Cardelli, and Salvatore Di Somma.
• Emergency Department, Sant'Andrea Hospital, School of Medicine and Psychology "Sapienza" Univesity, Rome, Italy. Electronic address: francesco.travaglino@gmail.com.
• Am J Emerg Med. 2014 Apr 1;32(4):334-41.

IntroductionMid-regional pro-atrial natriuretic peptide (MR-proANP), procalcitonin (PCT), and mid-regional pro-adrenomedullin (MR-proADM) demonstrated usefulness for management of emergency department patients with dyspnea.MethodsTo evaluate in patients with dyspnea, the prognostic value for 30 and 90 days mortality and readmission of PCT, MR-proADM, and MR-proANP, a multicenter prospective study was performed evaluating biomarkers at admission, 24 and 72 hours after admission. Based on final diagnosis, patients were divided into acute heart failure (AHF), primary lung diseases, or both (AHF + NO AHF).ResultsFive hundred one patients were enrolled. Procalcitonin and MR-proADM values at admission and at 72 hours were significantly (P < .001) predictive for 30-day mortality: baseline PCT with an area under the curve (AUC) of 0.70 and PCT at 72 hours with an AUC of 0.61; baseline MR-proADM with an AUC of 0.62 and MR-proADM at 72 hours with an AUC of 0.68. As for 90-day mortality, both PCT and MR-proADM baseline and 72 hours values showed a significant (P < .0001) predictive ability: baseline PCT with an AUC of 0.73 and 72 hours PCT with an AUC of 0.64; baseline MR-proADM with an AUC of 0.66 and 72 hours MR-proADM with an AUC of 0.71. In AHF, group biomarkers predicted rehospitalization and mortality at 90 days, whereas in AHF + NO AHF group, they predict mortality at 30 and 90 days.ConclusionsIn patients admitted for dyspnea, assessment of PCT plus MR-proADM improves risk stratification and management. Combined use of biomarkers is able to predict in the total cohort both rehospitalization and death at 30 and 90 days.Copyright © 2014 Elsevier Inc. All rights reserved.

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