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Mid-regional pro-adrenomedullin as a prognostic marker in sepsis: an observational study
Mirjam Christ-Crain1, Nils G Morgenthaler, Joachim Struck
1Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland.
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 samples 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 prospective 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 sandwich 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.
Insights
Mid-regional pro-adrenomedullin (MR-proADM) shows prognostic value in critically ill patients with sepsis. Higher MR-proADM levels on admission correlate with increased mortality risk, aiding in individual risk assessment.
Area of Science:
- Critical Care Medicine
- Biomarker Discovery
- Sepsis Pathophysiology
Background:
- Biomarker measurement offers potential for early sepsis assessment and mortality prediction.
- Evaluating prognostic markers is crucial for managing critically ill patients.
Purpose of the Study:
- To assess the prognostic capability of mid-regional pro-adrenomedullin (MR-proADM) in medical intensive care unit (ICU) patients.
- To compare MR-proADM's prognostic value against other biomarkers and physiological scores.
Main Methods:
- Blood samples from 101 ICU patients and 160 healthy controls were analyzed.
- MR-proADM levels were measured using a novel sandwich immunoassay.
- Prognostic value was compared with C-reactive Protein, IL-6, procalcitonin, and scoring systems.
Main Results:
- MR-proADM levels were significantly higher in non-survivors (sepsis, severe sepsis, septic shock) compared to survivors.
- The area under the curve (AUC) for MR-proADM in predicting sepsis survival was 0.81.
- MR-proADM demonstrated comparable prognostic accuracy to IL-6 and established scoring systems (APACHE II, SAPS II).
Conclusions:
- MR-proADM serves as a valuable tool for individual risk stratification in septic patients.
- This biomarker aids in predicting mortality risk within the critically ill population.