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Stable-State Midrange-Proadrenomedullin Level Is a Strong Predictor of Mortality in Patients With COPD
Maaike C Zuur-Telgen1, Marjolein G J Brusse-Keizer2, Paul D L P M VanderValk2
1Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede; Department of Internal Medicine, Medisch Spectrum Twente, Enschede.
Background:
Midrange-proadrenomedullin (MR-proADM) has been shown to be elevated in patients hospitalized for an acute exacerbation of COPD (AECOPD) and in patients with community-acquired pneumonia. When measured during AECOPDs, MR-proADM has also been shown to be a predictor of mortality. We hypothesized that MR-proADM levels measured in a stable state could also predict mortality.
Methods:
We included 181 patients in whom we had paired plasma samples for MR-proADM determinations during a stable state and at hospitalization for an AECOPD when they also produced sputum. Time to death or censoring was compared between patients with MR-proADM above or below the median of 0.71 nmol/L. The predictive value of MR-proADM for survival was determined by calculating the C statistic.
Results:
Patients with COPD and MR-proADM levels > 0.71 nmol/L in the stable state had a threefold-higher risk of dying than did patients with MR-proADM levels < 0.71 nmol/L (hazard ratio, 2.98 [95% CI, 1.51-5.90]; C statistic, 0.76). The corrected OR for 1-year mortality was 8.90 (95% CI, 1.94-44.6) in patients with high MR-proADM levels measured in the stable state, compared with patients with low levels measured in the stable state.
Conclusions:
MR-proADM measured in the stable state appeared to be a strong predictor of mortality in patients with COPD. MR-proADM is far easier to measure than other predictors of mortality in COPD, such as BMI, airflow obstruction, dyspnea, and exercise capacity score.
Insights
Midrange-proadrenomedullin (MR-proADM) measured during stable COPD predicts mortality. Higher MR-proADM levels in stable patients indicate a significantly increased risk of death, offering a simpler prognostic tool.
Area of Science:
- Biomarkers in Respiratory Disease
- Prognostic Indicators in Chronic Illness
- Cardiopulmonary Research
Background:
- Midrange-proadrenomedullin (MR-proADM) is elevated in acute exacerbations of COPD (AECOPD) and pneumonia.
- MR-proADM predicts mortality when measured during AECOPD.
- The prognostic value of MR-proADM in stable COPD is unexplored.
Purpose of the Study:
- To investigate if MR-proADM levels measured during stable COPD predict mortality.
- To evaluate MR-proADM as a prognostic marker in stable COPD patients.
Main Methods:
- 181 COPD patients with paired plasma samples (stable state and AECOPD) were analyzed.
- MR-proADM levels were compared between patients above and below the median (0.71 nmol/L).
- Survival analysis and C-statistic calculation were used to assess predictive value.
Main Results:
- Stable state MR-proADM > 0.71 nmol/L associated with a threefold higher mortality risk (HR 2.98).
- High MR-proADM in stable state predicted 1-year mortality with an odds ratio of 8.90.
- The C-statistic for MR-proADM's predictive value was 0.76.
Conclusions:
- MR-proADM measured during stable COPD is a strong predictor of mortality.
- MR-proADM offers a simpler alternative to existing COPD mortality predictors like BMI and lung function.
- This biomarker has potential for routine clinical use in COPD risk stratification.
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