Mid-regional pro-adrenomedullin (MR-proADM) Improves Disposition Strategies for Patients with Acute Dyspnoea: Results from the BACH trial

Objectives: To assess the value of Mid-regional pro-adrenomedullin (MR-proADM) in guiding patient disposition from the Emergency Department (ED), as one of the key factors of hospital resource utilization, in undifferentiated patients with acute dyspnoea. Methods: We used clinical and outcome data from a large international biomarker study (BACH trial) and analyzed data of all 1557 patients of the European and US sites presenting with acute dyspnoea. Patients were discharged or transferred from the ED to different levels of care (general ward, monitoring unit, intensive care unit). This original patient disposition was compared with the hypothetical disposition based on an adapted method of net reclassification improvement (NRI), which up-or downgraded patients from one level of care to the other based on the MR-proADM test result. Results: MR-pro-ADM was significantly higher in patients who died during the follow-up than in survivors (p<0.0001). When applying the adapted NRI model, 30 additional patients from the EU and 55 additional patients from the US were theoretically discharged (increase of 16.5%) had MR-proADM been used for patient management. The overall NRI, adding up the rates of up-and downgrades, in the EU was 16.0% (95% CI 8.2%-23.9%). A total of n=72 (9.9%) patients changed disposition when adding MR-pro ADM. In the US, the overall NRI was 12.0% (5.7%-18.4%) and a total of n=81 (11.2%) patients changed disposition. Conclusions: MR-proADM has the potential to guide initial disposition of undifferentiated ED patients with acute dyspnoea and might therefore be helpful to improve resource utilization and patient care.