Background: Despiteits recommendation in management guide lines for community acquired pneumonia (CAP), the CURB65 score is frequently not followed for disposition decisions in
clinical routine. We therefore proposed an improved
CURB65 A score, supplemented by proadre nome dull in (ProADM)
levels for patients with CAP and other lower respiratory tract infections
(LRTIs). In this study, we vali dated this risk based biomarker enhanced disposition in patients with LRTIs
presenting to the emergency department of the University Hospital
of Basel. Methods: In this prospective observational cohort study
of 85 patients presenting with LRTIs, site of care was decided by the
physicians in charge according to their judgement. Retro spectively the CURB65 A score was
calculated and a virtual disposition assigned. This was compared with the
existing disposition in order to identify efficacy of the novel risk based
biomarker enhanced disposition. Results: The novel disposition criteria considered 14
patients suitable for outpatient treatment compared to
 T. M. File Jr., “Case Studies of Lower Respiratory Tract Infections: Community-Acquired Pneumonia,” The American Journal of Medicine, Vol. 123, No. 4, 2010, pp. S4- 15. doi:10.1016/j.amjmed.2010.02.002
 D. Mertz and J. Johnstone, “Modern Management of Community-Acquired Pneumonia: Is It Cost-Effective and Are Outcomes Acceptable?” Current Infectious Disease Reports, Vol. 13, No. 3, 2011, pp. 269-277. doi:10.1007/s11908-011-0178-8
 G. W. Ruhnke, M. Coca-Perraillon, B. T. Kitch and D. M. Cutler, “Trends in Mortality and Medical Spending in Patients Hospitalized for Community-Acquired Pneumonia: 1993-2005,” Medical Care, Vol. 48, No. 12, 2010, pp. 1111-1116. doi:10.1097/MLR.0b013e3181f38006
 M. S. Niederman, J. S. McCombs, A. N. Unger, A. Kumar and R. Popovian, “The Cost of Treating Community- Acquired Pneumonia,” Clinical Therapeutics, Vol. 20, No. 4, 1998, pp. 820-837. doi:10.1016/S0149-2918(98)80144-6
 S. V. Monte, N. M Paolini, E. M Slazak, J. J. Schentag and J. A. Paladino, “Costs of Treating Lower Respiratory Tract Infections,” The American Journal of Managed Care, Vol. 14, No. 4, 2008, pp. 190-196.
 K. E. Covinsky, E. Pierluissi and C. B. Johnston, “Hospitalization-Associated Disability: ‘She Was Probably Able to Ambulate, but I’m Not Sure’,” The Journal of the American Medical Association, Vol. 306, No. 16, 2011, pp. 1782-1793. doi:10.1001/jama.2011.1556
 Reyes, S. R. Martinez, J. M. Vallés, E. Cases and R. Me- nendez, “Determinants of Hospital Costs in Community- Acquired Pneumonia,” The European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology, Vol. 31, No. 5, 2008, pp. 1061- 1067.
 M. J. Fine, T. E. Auble, D. M. Yealy, B. H. Hanusa, L. A. Weissfeld, D. E. Singer, C. M. Coley, T. J. Marrie and W. N. Kapoor, “A Prediction Rule to Identify Low-Risk Patients with Community-Acquired Pneumonia,” The New England Journal of Medicine, Vol. 336, No. 4, 1997, pp. 243-250. doi:10.1056/NEJM199701233360402
 W. S. Lim, M. M. van der Eerden, R. Laing, W. G. Boersma, N. Karalus, G. I. Town, S. A. Lewis and J. T. Mac- farlane, “Defining Community Acquired Pneumonia Se- verity on Presentation to Hospital: An International Derivation and Validation Study,” Thorax, Vol. 58, No. 5, 2003, pp. 377-382. doi:10.1136/thorax.58.5.377
 D. Aujesky, J. B. McCausland, J. Whittle, D. S. Obrosky, D. M. Yealy and M. J. Fine, “Reasons Why Emergency Department Providers Do Not Rely on the Pneumonia Severity Index to Determine the Initial Site of Treatment for Patients with Pneumonia,” Clinical Infectious Diseases, Vol. 49, No. 10, 2009, pp. e100-e108. doi:10.1086/644741
 A. R. Akram, J. D. Chalmers and A. T. Hill, “Predicting Mortality with Severity Assessment Tools in Out-Patients with Community-Acquired Pneumonia,” QJM: Monthly Journal of the Association of Physicians, Vol. 104, No. 10, 2011, pp. 871-879.
 P. Schuetz, D. Stolz, B. Mueller, N. G. Morgenthaler, J. Struck, C. Mueller, R. Bingisser, M. Tamm and M. Christ- Crain, “Endothelin-1 Precursor Peptides Correlate with Severity of Disease and Outcome in Patients with Community Acquired Pneumonia,” BMC Infectious Diseases, Vol. 8, 2008, p. 22. doi:10.1186/1471-2334-8-22
 M. Christ-Crain, D. Stolz, S.p Jutla, O. Couppis, C. Mül- ler, R. Bingisser and P. Schuetz, “Free and Total Cortisol Levels as Predictors of Severity and Outcome in Community-Acquired Pneumonia,” American Journal of Respiratory and Critical Care Medicine, Vol. 176, No. 9, 2007, pp. 913-920.
 S. Q. Khan, R. J. O’Brien, J. Struck, P. Quinn, N. Morgenthaler, I. Squire, J. Davies, A. Bergmann and L. L. Ng, “Prognostic Value of Midregional Pro-Adrenomedullin in Patients with Acute Myocardial Infarction. The LAMP (Leicester Acute Myocardial Infarction Peptide) Study,” Journal of the American College of Cardiology, Vol. 49, No. 14, 2007, pp. 1525-1532.
 M. Jougasaki, R. J. Rodeheffer, M. M. Redfield, K. Yamamoto, C. M. Wei, L. J. McKinley and J. C. Burnett Jr., “Cardiac Secretion of Adrenomedullin in Human Heart Failure,” The Journal of Clinical Investigation, Vol. 97, No. 10, 1996, pp. 2370-2376. doi:10.1172/JCI118680
 K. Kitamura, K. Kangawa, M. Kawamoto, Y. Ichiki, S. Nakamura, H. Matsuo and T. Eto, “Adrenomedullin: A Novel Hypotensive Peptide Isolated from Human Pheochromocytoma,” Biochemical and Biophysical Research Communications, Vol. 192, No. 2, 1993, pp. 553-560. doi:10.1006/bbrc.1993.1451
 R. Q. Wu, W. F. Dong, X. L. Qiang, Y. X. Ji, T. P. Cui, J. T. Yang and M. Zhou, “Human Vasoactive Hormone Adrenomedullin and Its Binding Protein Rescue Experimental Animals from Shock,” Peptides, Vol. 29, No. 7, 200, pp. 1223-1230. doi:10.1016/j.peptides.2008.02.021
 D. Bell and B. J. McDermott, “Intermedin (Adrenomedullin-2): A Novel Counter-Regulatory Peptide in the Cardiovascular and Renal Systems,” British Journal of Pharmacology, Vol. 153, No. 1, 2008, pp. S247-S262. doi:10.1038/sj.bjp.0707494
 P. Schuetz, M. Wolbers, M. Christ-Crain, R. Thomann, C. Falconnier, I. Widmer and S. Neidert, “Prohormones for Prediction of Adverse Medical Outcome in Community- Acquired Pneumonia and Lower Respiratory Tract Infections,” Critical Care, Vol. 14, No. 3, 2010, p. R106.
 M. Christ-Crain, N. G Morgenthaler, D. Stolz, C. Müller, R. Bingisser, S. Harbarth, M. Tamm, J. Struck, A. Bergmann and B. Müller, “Pro-Adrenomedullin to Predict Severity and Outcome in Community-Acquired Pneumonia,” Critical Care, Vol. 10, No. 3, 2006, p. R96.
 W. C. Albrich, F. Dusemund, K. Rüegger, M. Christ- Crain, W. Zimmerli, T. Bregenzer, S. Irani, et al., “En- hancement of CURB65 Score with Proadrenomedullin (CURB65-A) for Outcome Prediction in Lower Respiratory Tract Infections: Derivation of a Clinical Algorithm,” BMC Infectious Diseases, Vol. 11, 2011, p. 112. doi:10.1186/1471-2334-11-112
 W. C. Albrich, K. Rüegger, F. Dusemund, R. Bossart, K. Regez, U. Schild and A. Conca, “Optimised Patient Transfer Using an Innovative Multidisciplinary Assessment in Kanton Aargau (OPTIMA IAarau): An Observational Survey in Lower Respiratory Tract Infections,” Swiss Medical Wweekly, Vol. 141, 2011, Article ID: w13237.
 N. G. Morgenthaler, J. Struck, C. Alonso and A. Bergmann, “Measurement of Midregional Proadrenomedullin in Plasma with an Immunoluminometric Assay,” Clinical Chemistry, Vol. 51, No. 10, 2005, pp. 1823-1829. doi:10.1373/clinchem.2005.051110
 S. M. Louis, M. P. Kossovsky, P. Chopard, P. Sigaud, T. V. Perneger and J. M. Gaspoz, “A Predictive Score to Identify Hospitalized Patients’ Risk of Discharge to a Post-Acute Care Facility,” BMC Health Services Re- search, Vol. 8, 2008, p. 154. doi:10.1186/1472-6963-8-154
 C. Baehni, S. Meier, P. Spreiter, U. Schild, K. Regez, R. Bossart, R. Thomann, et al., “Which Patients with Lower Respiratory Tract Infections Need Inpatient Treatment? Perceptions of Physicians, Nurses, Patients and Relatives,” BMC Pulmonary Medicine, Vol. 10, 2010, p. 12. doi:10.1186/1471-2466-10-12