Specialist commentator comments

Comments on this technology were invited from clinical specialists working in the field and relevant patient organisations. The comments received are individual opinions and do not represent NICE's view.

All specialists were familiar with MR-proADM and 2 specialists had used it in a research setting.

Level of innovation

Two specialists noted that MR-proADM was a novel biomarker and they did not know of any other tests available to measure this. All specialists agreed that measuring mid-regional proadrenomedullin (MR-proADM) could better inform triaging of patients compared with National Early Warning Score (NEWS/NEWS2) alone. Two specialists mentioned that further validation of the test would be needed. Another specialist stated that the test results would need to be available at the point of care to deliver patient and system benefits.

Potential patient impact

One specialist stated that results from MR-proADM testing, when used alongside NEWS2, would likely help clinicians make better decisions about care for people with suspected infection and sepsis. This could potentially avoid admissions and allow for earlier transfer to high dependency and intensive care units.

One specialist stated that the test may be useful as a rule-out test for suspected infection and sepsis, and could lead to quicker discharge for some patients. However, this specialist stated that this would need to be evaluated in a prospective study directly comparing decisions based on NEWS2 with decisions based on MR-proADM results alongside NEWS2. This specialist also noted that there was no evidence directly comparing NEWS2 with NEWS2 and MR-proADM.

One specialist noted that the test would probably be used in adults attending emergency departments and further testing was needed to evaluate the effectiveness in children and people with immunosuppression.

Potential system impact

One specialist stated that MR‑proADM could allow safer discharge of patients and lower readmission rates, as well as earlier and more accurate triaging. This could improve clinical outcomes and cost savings. One specialist stated that the test could lead to earlier, safe, patient discharge.

One specialist stated that MR-proADM could help with 4‑hour waiting time targets in emergency departments. However, they noted that there was limited evidence to support this. One specialist noted that the technology could be very helpful to emergency department staff who often have to make difficult decisions under pressure.

All specialists agreed that this technology would be an additional cost to current care. Further evidence would be needed to show that using the test would improve outcomes and result in cost savings.

Although running the test on the Kryptor analyser takes around 30 minutes, 1 specialist commentator noted that the test cannot be run immediately and that if sample transport, processing and reporting are considered it usually takes over an hour for results to be available. Two specialist commentators noted that a point-of-care test would be a better option to provide results as soon as possible. One specialist noted that results would need to be available within 1 hour for risk stratification. This is because patients at high risk must have antibiotics within 1 hour (medium risk within 3 hours and patients at low risk may not need antibiotics).

One specialist commentator noted that the Kryptor platform is semi-automated (rather than fully automated) and does not fit with current workflows in most NHS labs that use high-throughput automated platforms. Two specialists stated that the Kryptor platform is not widely available in the NHS.

General comments

One specialist commentator noted that MR-proADM is a non-specific marker for infection and that it reflects disease severity for many conditions, including infection.