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Published on: June 12, 2021
Elevated Plasma Bioactive Adrenomedullin and Mortality in Cardiogenic Shock: Results from the OptimaCC Trial
Koji Takagi1,2, Bruno Levy3,4,5, Antoine Kimmoun1,3,4,5
1Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), Université de Paris, 75010 Paris, France.
Insights
Higher bioactive adrenomedullin (bio-ADM) levels indicate a worse prognosis in patients with cardiogenic shock (CS). Elevated bio-ADM is linked to increased mortality risk and organ dysfunction in CS patients.
Area of Science:
- Cardiology
- Biomarkers
- Critical Care Medicine
Background:
- Bioactive adrenomedullin (bio-ADM) is a recognized prognostic marker in acute circulatory failure.
- Cardiogenic shock (CS) presents significant challenges in patient management and outcome prediction.
Purpose of the Study:
- To investigate the association between bio-ADM levels and organ injury, functional impairment, and survival in patients with CS.
- To determine the prognostic value of bio-ADM for 30-day mortality in CS.
Main Methods:
- A post-hoc analysis of the multicenter, randomized OptimaCC trial involving 57 CS patients.
- Primary endpoint: association between bio-ADM and 30-day all-cause mortality.
- Secondary endpoints: adverse events, organ injury, and functional impairment parameters.
Main Results:
- Bio-ADM levels were significantly higher in 30-day non-survivors compared to survivors at inclusion and up to 48 hours.
- A bio-ADM cutoff of 53.8 pg/mL was associated with a 3.90-fold increased risk of 30-day mortality, even after adjusting for severity scores.
- Elevated bio-ADM correlated with refractory CS, pulmonary vascular resistance, impaired glomerular filtration rate, and NT-proBNP levels.
Conclusions:
- Bio-ADM levels in CS patients are associated with indicators of organ injury and functional impairment.
- Bio-ADM serves as a prognostic indicator for refractory CS and 30-day mortality in this patient population.
Aims:
Bioactive adrenomedullin (bio-ADM) was recently shown to be a prognostic marker in patients with acute circulatory failure. We investigate the association of bio-ADM with organ injury, functional impairment, and survival in cardiogenic shock (CS).
Methods:
OptimaCC was a multicenter and randomized trial in 57 patients with CS. In this post-hoc analysis, the primary endpoint was to assess the association between bio-ADM and 30-day all-cause mortality. Secondary endpoints included adverse events and parameters of organ injury or functional impairment.
Results:
Bio-ADM values were higher in 30-day non-survivors than 30-day survivors at inclusion (median (interquartile range) 67.0 (54.6-142.9) pg/mL vs. 38.7 (23.8-63.6) pg/mL, p = 0.010), at 24 h (p = 0.012), and up to 48 h (p = 0.027). Using a bio-ADM cutoff of 53.8 pg/mL, patients with increased bio-ADM had a HR of 3.90 (95% confidence interval 1.43-10.68, p = 0.008) for 30-day all-cause mortality, and similar results were observed even after adjustment for severity scores. Patients with the occurrence of refractory CS had higher bio-ADM value at inclusion (90.7 (59.9-147.7) pg/mL vs. 40.7 (23.0-64.7) pg/mL p = 0.005). Bio-ADM values at inclusion were correlated with pulmonary vascular resistance index, estimated glomerular filtration rate, and N-terminal pro-B-type natriuretic peptide (r = 0.49, r = -0.47, and r = 0.64, respectively; p < 0.001).
Conclusions:
In CS patients, the values of bio-ADM are associated with some parameters of organ injury and functional impairment and are prognostic for the occurrence of refractory CS and 30-day mortality.
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