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MR- proADM to detect specific types of organ failure in infection
Cristina Andrés1, David Andaluz-Ojeda2, Ramón Cicuendez2
1Clinical Analysis Service, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
Background:
Following the SEPSIS-3 consensus, detection of organ failure as assessed by the SOFA (Sequential Organ Failure Assessment) score, is mandatory to detect sepsis. Calculating SOFA outside of the Intensive Care Unit (ICU) is challenging. The alternative in this scenario, the quick SOFA, is very specific but less sensible. Biomarkers could help to detect the presence of organ failure secondary to infection either in ICU and non-ICU settings.
Materials And Methods:
We evaluated the ability of four biomarkers (C-Reactive protein (CRP), lactate, mid-regional proadrenomedullin (MR-proADM) and procalcitonin (PCT)) to detect each kind of organ failure considered in the SOFA in 213 patients with infection, sepsis or septic shock, by using multivariate regression analysis and calculation of the area under the receiver operating curve (AUROC).
Results:
In the multivariate analysis, MR-proADM was an independent predictor of five different failures (respiratory, coagulation, cardiovascular, neurological and renal). In turn, lactate predicted three (coagulation, cardiovascular and neurological) and PCT two (cardiovascular and renal). CRP did not predict any of the individual components of SOFA. The highest AUROCs were those of MR-proADM and PCT to detect cardiovascular (AUROC, CI95%): MR-proADM (0.82 [0.76-0.88]), PCT (0.81 [0.75-0.87] (P < .05) and renal failure: MR-proADM (0.87 [0.82-0.92]), PCT (0.81 [0.75-0.86]), (P < .05). None of the biomarkers tested was able to detect hepatic failure.
Conclusions:
In patients with infection, MR-proADM was the biomarker detecting the largest number of SOFA score components, with the exception of hepatic failure.
Insights
Mid-regional proadrenomedullin (MR-proADM) effectively detects multiple organ failures in sepsis patients, outperforming other biomarkers like lactate and procalcitonin. This finding aids in assessing sepsis severity outside the ICU.
Area of Science:
- Critical Care Medicine
- Biomarker Research
- Infectious Diseases
Background:
- Sepsis diagnosis relies on Sequential Organ Failure Assessment (SOFA) scores, challenging to calculate outside Intensive Care Units (ICUs).
- Quick SOFA (qSOFA) offers specificity but limited sensitivity for organ dysfunction in sepsis.
- Biomarkers may improve organ failure detection in infection and sepsis, both in and out of the ICU.
Purpose of the Study:
- To evaluate the efficacy of four biomarkers (CRP, lactate, MR-proADM, PCT) in detecting individual organ failures defined by the SOFA score.
- To compare the predictive performance of these biomarkers using multivariate regression and AUROC analysis in patients with infection, sepsis, or septic shock.
Main Methods:
- Assessed four biomarkers: C-Reactive Protein (CRP), lactate, mid-regional proadrenomedullin (MR-proADM), and procalcitonin (PCT).
- Utilized multivariate regression analysis and Area Under the Receiver Operating Curve (AUROC) calculations.
- Analyzed data from 213 patients diagnosed with infection, sepsis, or septic shock.
Main Results:
- MR-proADM independently predicted five SOFA components: respiratory, coagulation, cardiovascular, neurological, and renal failure.
- Lactate predicted three components (coagulation, cardiovascular, neurological), while PCT predicted two (cardiovascular, renal).
- MR-proADM and PCT showed the highest AUROCs for cardiovascular and renal failure detection; CRP did not predict any SOFA component. Hepatic failure was not detected by any biomarker.
Conclusions:
- MR-proADM emerged as the most effective biomarker for detecting multiple SOFA score components in patients with infection, excluding hepatic failure.
- These findings suggest MR-proADM's potential utility in assessing organ dysfunction in sepsis, particularly when SOFA calculation is difficult.
