Mid-Regional Pro-Adrenomedullin as a Translational Biomarker of Microcirculatory Dysfunction in Sepsis: A Prospective...

Area of Science:

• Critical care medicine
• Biomarker research
• Microcirculation physiology

Background:

• Endothelial dysfunction is a key feature of sepsis.
• Mid-regional pro-adrenomedullin (MR-proADM) is a known biomarker for endothelial dysfunction.
• The real-time relationship between MR-proADM and microcirculatory alterations in critically ill patients requires further investigation.

Purpose of the Study:

• To investigate the association between MR-proADM concentrations and microcirculatory alterations in intensive care unit (ICU) patients with sepsis.
• To evaluate the correlation of MR-proADM with disease severity and patient outcomes.
• To assess the predictive value of MR-proADM for specific clinical outcomes like renal replacement therapy.

Main Methods:

• Prospective cohort study of 59 ICU patients with sepsis.
• Serial sublingual microcirculation assessments using sidestream dark field (SDF) imaging.
• Serum MR-proADM concentrations measured by BRAHMS Kryptor assays; automated software for microvascular analysis.

Main Results:

• Higher admission MR-proADM levels showed modest associations with impaired microvascular perfusion (PNOC, PDBD, CPPV).
• Increasing MR-proADM levels over time strongly correlated with worsening microvascular perfusion (ΔPDBD, ΔPNOC).
• MR-proADM correlated with SOFA and APACHE II scores and predicted the need for renal replacement therapy (AUC = 0.799).

Conclusions:

• MR-proADM concentrations are associated with in vivo microcirculatory dysfunction in sepsis.
• The dynamic changes in MR-proADM levels correlate with microvascular impairment.
• MR-proADM shows potential as a translational biomarker for monitoring endothelial and microcirculatory failure in critically ill sepsis patients.