Another brick in the wall: adrenomedullin and prognosis in community-acquired pneumonia.

C ommunity-acquired pneumonia (CAP) continues to be a major healthcare problem. The associated mortality of 14% in hospitalised patients is still high [1]. Established clinical scores, such as the Pneumonia Severity Index (PSI) and CRB-65 score (confusion, respiratory frequency o30 breaths?min, systolic blood pressure ,90 mmHg or diastolic blood pressure f60 mmHg, and age o65 yrs) are used for the determination of mortality risk. Since CAP is an infectious disease, we traditionally use biomarkers of infection for diagnostic and prognostic purposes. Inflammatory markers such as white blood cell (WBC) count and C-reactive protein (CRP) are still widely used in the management of CAP, although it is well known that their value for the diagnosis of clinically relevant bacterial infection and prediction of death and complications in CAP is limited. With respect to better diagnosis and guidance of antibiotic therapy, procalcitonin (PCT) is much better, with a broad spectrum of interventional studies in the field of lower respiratory tract infections [2]. However, PCT is not the ideal biomarker for prognosis in CAP, where cardiovascular biomarkers show better predictive value [3–5].