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Mid-Regional Pro-Adrenomedullin Can Predict Organ Failure and Prognosis in Sepsis?
Silvia Spoto1, Stefania Basili2, Roberto Cangemi2
1Diagnostic and Therapeutic Medicine Department, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy.
Abstract:
Sepsis causes immune dysregulation and endotheliitis, with an increase in mid-regional pro-adrenomedullin (MR-proADM). The aim of the study is to determine an MR-proADM value that, in addition to clinical diagnosis, can identify patients with localized infection or those with sepsis/septic shock, with specific organ damage or with the need for intensive care unit (ICU) transfer and prognosis. The secondary aim is to correlate the MR-proADM value with the length of stay (LOS). In total, 301 subjects with sepsis (124/301 with septic shock) and 126 with localized infection were retrospectively included. In sepsis, MR-proADM ≥ 3.39 ng/mL identified acute kidney injury (AKI); ≥2.99 ng/mL acute respiratory distress syndrome (ARDS); ≥2.28 ng/mL acute heart failure (AHF); ≥2.55 ng/mL Glascow Coma Scale (GCS) < 15; ≥3.38 multi-organ involvement; ≥3.33 need for ICU transfer; ≥2.0 Sequential Organ Failure Assessment (SOFA) score ≥ 2; and ≥3.15 ng/mL non-survivors. The multivariate analysis showed that MR-proADM ≥ 2 ng/mL correlates with AKI, anemia and SOFA score ≥ 2, and MR-proADM ≥ 3 ng/mL correlates with AKI, GCS < 15 and SOFA score ≥ 2. A correlation between mortality and AKI, GCS < 15, ICU transfer and cathecolamine administration was found. In localized infection, MR-proADM at admission ≥ 1.44 ng/mL identified patients with AKI; ≥1.0 ng/mL with AHF; and ≥1.44 ng/mL with anemia and SOFA score ≥ 2. In the multivariate analysis, MR-proADM ≥ 1.44 ng/mL correlated with AKI, anemia, SOFA score ≥ 2 and AHF. MR-proADM is a marker of oxidative stress due to an infection, reflecting severity proportionally to organ damage.
Insights
Mid-regional pro-adrenomedullin (MR-proADM) levels can help identify sepsis severity and organ damage. Elevated MR-proADM indicates increased risk for acute kidney injury, respiratory distress, and need for intensive care unit transfer.
Area of Science:
- Biochemistry
- Clinical Medicine
- Critical Care Medicine
Background:
- Sepsis triggers immune dysregulation and endotheliitis, marked by elevated mid-regional pro-adrenomedullin (MR-proADM).
- Accurate identification of sepsis severity and organ damage is crucial for timely intervention.
Purpose of the Study:
- To establish MR-proADM thresholds for identifying localized infection versus sepsis/septic shock.
- To correlate MR-proADM levels with specific organ damage, intensive care unit (ICU) transfer, and prognosis.
- To assess the relationship between MR-proADM and length of stay (LOS).
Main Methods:
- Retrospective analysis of 301 sepsis patients (124 with septic shock) and 126 with localized infection.
- Determination of MR-proADM cut-off values for various clinical outcomes in sepsis and localized infection.
- Multivariate analysis to identify independent correlations between MR-proADM and clinical parameters.
Main Results:
- In sepsis, specific MR-proADM levels correlated with acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), acute heart failure (AHF), low Glasgow Coma Scale (GCS), multi-organ involvement, ICU transfer, and mortality.
- Multivariate analysis confirmed MR-proADM thresholds correlating with AKI, anemia, and SOFA scores ≥ 2.
- In localized infection, MR-proADM levels identified AKI, AHF, anemia, and SOFA scores ≥ 2.
Conclusions:
- MR-proADM serves as a valuable biomarker for infection severity, proportionally reflecting organ damage.
- Established MR-proADM thresholds aid in differentiating infection types and predicting patient outcomes.
- MR-proADM levels correlate with key indicators of sepsis severity and organ dysfunction.
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