A Pilot Study on the Diagnostic Accuracy of Proadrenomedullin and Proatrial Natriuretic Peptide in Lower Respiratory Tract Infections

Agustín Ruiz-González*, 1, Aureli Esquerda 2, José M Porcel 1, Silvia Bielsa 1, Horacio Valencia 1, Gonzalo Cao 2, Miquel Falguera 1
1 Department of Internal Medicine, Arnau de Vilanova University Hospital, IRBLLEIDA, Lleida, Spain
2 Department of Laboratory Medicine, Arnau de Vilanova University Hospital, IRBLLEIDA, Lleida, Spain

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© Ruiz-González et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Department of Internal Medicine, Arnau de Vilanova University Hospital, IRBLLEIDA. C/ Rovira Roure 80. 25198 Lleida, Spain; Tel: +34 973 248100; Fax: +34 973 288754.; E-mail:


Background :

Pneumonia is the leading cause of death among infectious diseases in developed countries. However, the severity of pneumonia requiring hospitalization often makes the initial diagnosis difficult because of an equivocal clinical picture or interpretation of the chest film. The objective of the present study was to assess the usefulness of the plasma levels of mid-regional proadrenomedullin (MR-proADM) and mid-regional proatrial natriuretic peptide (MR-proANP) in differentiating pneumonia from other lower respiratory tract infections (LRTIs).

Methods :

A retrospective study was conducted. The plasma levels of MR-proADM and MR-proANP were measured in 85 patients hospitalized for LRTIs, 56 of whom with diagnosis of pneumonia and 29 with other LRTIs.

Results :

The patients with pneumonia had increased MR-proADM levels (median 1.46 nmol/L [IQR 25-75, 0.82-2.02 nmol/L]) compared with the patients with other LRTIs (median 0.88 nmol/mL [0.71-1.39 nmol/L]) (p= 0.04). However, the MR-proANP levels did not show differences between the groups. The optimal threshold of MR-proADM to predict pneumonia was 1.5 nmol/L, which yielded a sensitivity of 51.7% (95% CI, 38.0-65.3), a 79.3% specificity (95% CI, 60.3-92.0), and an odds ratio of 6.64 (95% CI, 1.32-32.85). The combination of this parameter with C-reactive protein in an “and” rule increased the specificity for detecting pneumonia significantly.

Conclusion :

MR-proADM levels (but not MR-proANP levels) are increased in patients with pneumonia although its discriminatory power is moderate.

Keywords: Adrenomedullin, atrial natriuretic peptide, biomarkers, diagnosis, pneumonia..