***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Proadrenomedullin ( ProADM ) confers additional prognostic information to established clinical risk scores in lower respiratory tract infections ( LRTI ) . We aim ed to derive a practical algorithm combining the CURB65 score with ProADM-levels in patients with community-acquired pneumonia ( CAP ) and non-CAP-LRTI . Methods We used data of 1359 patients with LRTI enrolled in a multicenter study . We chose two ProADM cut-off values by assessing the association between ProADM levels and the risk of adverse events and mortality . A composite score ( CURB65-A ) was created combining CURB65 classes with ProADM cut-offs to further risk-stratify patients . Results CURB65 and ProADM predicted both adverse events and mortality similarly well in CAP and non-CAP-LRTI . The combined CURB65-A risk score provided better prediction of death and adverse events than the CURB65 score in the entire cohort and in CAP and non-CAP-LRTI patients . Within each CURB65 class , higher ProADM-levels were associated with an increased risk of adverse events and mortality . Overall , risk of adverse events ( 3.9 % ) and mortality ( 0.65 % ) was low for patients with CURB65 score 0 - 1 and ProADM ≤0.75 nmol/l ( CURB65-A risk class I ) ; intermediate ( 8.6 % and 2.6 % , respectively ) for patients with CURB65 score of 2 and ProADM ≤1.5 nmol/l or CURB classes 0 - 1 and ProADM levels between 0.75 - 1.5 nmol/L ( CURB65-A risk class II ) , and high ( 21.6 % and 9.8 % , respectively ) for all other patients ( CURB65-A risk class III ) . If outpatient treatment was recommended for CURB65-A risk class I and short hospitalization for CURB65-A risk class II , 17.9 % and 40.8 % of 1217 hospitalized patients could have received ambulatory treatment or a short hospitalization , respectively . Conclusions The new CURB65-A risk score combining CURB65 risk classes with ProADM cut-off values accurately predicts adverse events and mortality in patients with CAP and non-CAP-LRTI . Additional prospect i ve cohort or intervention studies need to vali date this score and demonstrate its safety and efficacy for the management of patients with LRTI.Trial Registration Procalcitonin-guided antibiotic therapy and hospitalisation in patients with lower respiratory tract infections : the prohosp study ; is rct n.org Identifier : IS RCT N : IS RCT BACKGROUND Midregional proadrenomedullin ( MR-proADM ) is a potential prognostic biomarker in patients with community-acquired pneumonia ( CAP ) . Previous work has been hampered by sample size and illness spectrum limits . We sought to describe the pattern of MR-proADM in a broad CAP cohort , confirm its prognostic role , and compare its performance to procalcitonin , a novel biomarker of infection . METHODS We conducted a multicenter prospect i ve cohort study in 28 community and teaching EDs . Patients with a clinical and radiographic diagnosis of CAP were enrolled . We stratified MR-proADM levels a priori into quartiles and quantified severity of illness using the pneumonia severity index ( PSI ) ; and confusion ( abbreviated mental test score of < or= 8) , urea > or= 7 mmol/L , respiratory rate > or= 30 breaths/min , BP < 90 mm Hg systolic or < 60 mm Hg diastolic , age > or= 65 years ( CURB-65 ) . The primary outcome was 30-day mortality . RESULTS A total of 1,653 patients formed the study cohort .  MR-proADM levels consistently rose with PSI class and 30-day mortality ( p < 0.001 ) . MR-proADM had a higher area under the curve for 30-day mortality than procalcitonin ( 0.76 vs 0.65 , respectively ; p < 0.001 ) , but adding MR-proADM to the PSI in all subjects minimally improved performance . Among low-risk subjects ( PSI classes I to III ) , mortality was low and did not differ by MR-proADM quartile . However , among high-risk subjects ( PSI class IV/V ; n = 546 ) , subjects in the highest MR-proADM quartile ( n = 232 ; 42 % ) had higher 30-day mortality than those in MR-proADM quartiles 1 to 3 ( 23 % vs 9 % , respectively ; p < 0.0001 ) . Similar results were seen with CURB-65 . MR-proADM and procalcitonin levels were generally concordant ; only 6 % of PSI class IV/V subjects in the highest MR-proADM quartile had very low procalcitonin levels ( < 0.1 ng/mL ) . CONCLUSIONS In our multicenter CAP cohort , MR-proADM levels correlate with increasing severity of illness and death . High MR-proADM levels offer additional risk stratification in high-risk CAP patients , but otherwise MR-proADM levels do not alter PSI-based risk assessment in most CAP patients Introduction Measurement of biomarkers is a potential approach to early assessment and prediction of mortality in patients with sepsis . The aim of the present study was to evaluate the prognostic value of mid-regional pro-adrenomedullin ( MR-proADM ) levels in a cohort of medical intensive care patients and to compare it with other biomarkers and physiological scores . Method We evaluated blood sample s from 101 consecutive critically ill patients admitted to the intensive care unit and from 160 age-matched healthy control individuals . The patients had initially been enrolled in a prospect i ve observational study investigating the prognostic value of endocrine dysfunction in critically ill patients ( " PEDCRIP " Study ) . The prognostic value of MR-proADM levels was compared with those of two physiological scores and of various biomarkers ( for example C-reactive Protein , IL-6 , procalcitonin ) . MR-proADM was measured in EDTA plasma from all patients using a new s and wich immunoassay . Results On admission , 53 patients had sepsis , severe sepsis , or septic shock , and 48 had systemic inflammatory response syndrome .  Median MR-proADM levels on admission ( nmol/l [ range ] ) were 1.1 ( 0.3–3.7 ) in patients with systemic inflammatory response syndrome , 1.8 ( 0.4–5.8 ) in those with sepsis , 2.3 ( 1.0–17.6 ) in those with severe sepsis and 4.5 ( 0.9–21 ) in patients with septic shock . In healthy control individuals the median MR-proADM was 0.4 ( 0.21–0.97 ) . On admission , circulating MR-proADM levels in patients with sepsis , severe sepsis , or septic shock were significantly higher in nonsurvivors ( 8.5 [ 0.8–21.0 ] ; P < 0.001 ) than in survivors ( 1.7 [ 0.4–17.6 ] ) . In a receiver operating curve analysis of survival of patients with sepsis , the area under the curve ( AUC ) for MR-proADM was 0.81 , which was similar to the AUCs for IL-6 , Acute Physiology and Chronic Health Evaluation II score and Simplified Acute Physiology Score II . The prognostic value of MR-proADM was independent of the sepsis classification system used . Conclusion MR-proADM may be helpful in individual risk assessment in septic patients Background : Prognostic scales provide a useful tool to predict mortality in community-acquired pneumonia ( CAP ) . However , the inflammatory response of the host , crucial in resolution and outcome , is not included in the prognostic scales . Methods : The aim of this study was to investigate whether information about the initial inflammatory cytokine profile and markers increases the accuracy of prognostic scales to predict 30-day mortality . To this aim , a prospect i ve cohort study in two tertiary care hospitals was design ed . Procalcitonin ( PCT ) , C-reactive protein ( CRP ) and the systemic cytokines tumour necrosis factor α ( TNFα ) and interleukins IL6 , IL8 and IL10 were measured at admission . Initial severity was assessed by PSI ( Pneumonia Severity Index ) , CURB65 ( Confusion , Urea nitrogen , Respiratory rate , Blood pressure , ≥65 years of age ) and CRB65 ( Confusion , Respiratory rate , Blood pressure , ≥65 years of age ) scales . A total of 453 hospitalised CAP patients were included . Results : The 36 patients who died ( 7.8 % ) had significantly increased levels of IL6 , IL8 , PCT and CRP . In regression logistic analyses , high levels of CRP and IL6 showed an independent predictive value for predicting 30-day mortality , after adjustment for prognostic scales . Adding CRP to PSI significantly increased the area under the receiver operating characteristic curve ( AUC ) from 0.80 to 0.85 , that of CURB65 from 0.82 to 0.85 and that of CRB65 from 0.79 to 0.85 . Adding IL6 or PCT values  to CRP did not significantly increase the AUC of any scale . When using two scales ( PSI and CURB65/CRB65 ) and CRP simultaneously the AUC was 0.88 . Conclusions : Adding CRP levels to PSI , CURB65 and CRB65 scales improves the 30-day mortality prediction . The highest predictive value is reached with a combination of two scales and CRP . Further validation of that improvement is needed Objectives To quantify the diagnostic accuracy of selected inflammatory markers in addition to symptoms and signs for predicting pneumonia and to derive a diagnostic tool . Design Diagnostic study performed between 2007 and 2010 . Participants had their history taken , underwent  physical examination and measurement of C reactive protein ( CRP ) and procalcitonin in venous blood  on the day they first consulted , and underwent chest radiography within seven days . Setting Primary care centres in 12 European countries . Participants Adults presenting with acute cough . Main outcome measures Pneumonia as determined by radiologists , who were blind to all other information when they judged chest radiographs . Results Of 3106 eligible patients , 286 were excluded because of missing or inadequate chest radiographs , leaving 2820 patients ( mean age 50 , 40 % men ) of whom 140 ( 5 % ) had pneumonia . Re- assessment of a subset of 1675 chest radiographs showed agreement in 94 % ( κ 0.45 , 95 % confidence interval 0.36 to 0.54 ) . Six published “ symptoms and signs models ” varied in their discrimination ( area under receiver operating characteristics curve ( ROC ) ranged from 0.55 ( 95 % confidence interval 0.50 to 0.61 ) to 0.71 ( 0.66 to 0.76 ) ) . The optimal combination of clinical prediction items derived from our patients included absence of runny nose and presence of breathlessness , crackles and diminished breath sounds on auscultation , tachycardia , and fever , with an ROC area of 0.70 ( 0.65 to 0.75 ) . Addition of CRP at the optimal cut off of > 30 mg/L increased the ROC area to 0.77 ( 0.73 to 0.81 ) and improved the diagnostic classification ( net reclassification improvement 28 % ) . In the 1556 patients classified according to symptoms , signs , and CRP > 30 mg/L as “ low risk ” ( < 2.5 % ) for pneumonia , the prevalence of pneumonia was 2 % . In the 132 patients classified as “ high risk ” ( > 20 % ) , the prevalence of pneumonia was 31 % . The positive likelihood ratio of low , intermediate , and high risk for pneumonia was 0.4 , 1.2 , and 8.6 respectively . Measurement of procalcitonin added no relevant additional diagnostic information . A simplified diagnostic score based on symptoms , signs , and CRP > 30 mg/L result ed in proportions of pneumonia of 0.7 % , 3.8 % , and 18.2 % in the low , intermediate , and high risk group respectively . Conclusions A clinical rule based on symptoms and signs to predict pneumonia in patients presenting to primary care with acute cough performed best in patients with mild or severe clinical presentation . Addition of CRP concentration at the optimal cut off of > 30 mg/L improved diagnostic information , but measurement of procalcitonin  concentration did not add clinical ly relevant information in this group Biomarkers are useful in community-acquired pneumonia ( CAP ) . Recently , midregional ( MR ) proadrenomedullin ( proADM ) has been shown to be of potential prognostic use . We sought to determine whether this prognostic role depends on the cause of CAP . We conducted a prospect i ve cohort study of immunocompetent patients with CAP . Pneumonia Severity Index ( PSI ) and CURB-65 score ( confusion ( abbreviated mental test score of ≤8 ) , urea ≥7 mol 
    Output:
    
Conclusions Our study has demonstrated that MR-proADM is predictive of increased complications and higher mortality rates in patients suffering from CAP .