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Prognostic accuracy of mid-regional proadrenomedullin in patients with sepsis - A longitudinal observational study
Akshita Makkar1, H L Khushboo2, Mukesh Bairwa1
1Department of Internal Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
Background:
Prognostication in sepsis remains challenging as conventional scores and biomarkers, including procalcitonin (PCT) and lactate, show limited predictive strength when used alone. This study evaluated the ability of mid-regional proadrenomedullin (MR-proADM) to predict 14-day mortality in patients with sepsis, intending to improve early risk stratification.
Methods:
A prospective observational study was conducted at a tertiary hospital in North India over 18 months. One hundred and twenty patients admitted to the intensive care unit (ICU) and ward with sepsis were enrolled. On admission, serum MR-proADM, PCT, and lactate were measured, and Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were calculated. Prognostic accuracy was determined using the receiver operating characteristic (ROC) analysis.
Results:
The mean age of the participants was 45.9 ± 16.1 years, with 54.2% male. Nonsurvivors (n = 56) required ICU care more frequently (69.6%) and ventilator support (55.4%). MR-proADM levels were significantly higher in nonsurvivors (2.48 ± 1.93 nmol/L) than survivors (1.43 ± 0.78 nmol/L, P < 0.001). MR-proADM achieved an area under ROC of 0.767, which was comparable to SOFA (0.712), lower than lactate (0.807), and superior to PCT (0.693) and APACHE II (0.699). MR-proADM >5.75 nmol/L was uniformly associated with mortality.
Conclusion:
MR-proADM is a reliable adjunctive prognostic biomarker for sepsis and may enhance early risk stratification when used alongside established scores and biomarkers.
Insights
Mid-regional proadrenomedullin (MR-proADM) shows promise in predicting sepsis mortality, offering improved risk stratification. This biomarker, when used with existing methods, aids in better patient outcomes.
Area of Science:
- Critical Care Medicine
- Biomarker Discovery
- Sepsis Pathophysiology
Background:
- Sepsis prognostication is challenging with current scores and biomarkers like procalcitonin (PCT) and lactate.
- Limited predictive power of individual markers necessitates improved risk stratification tools.
Purpose of the Study:
- To evaluate mid-regional proadrenomedullin (MR-proADM) for predicting 14-day mortality in sepsis patients.
- To assess MR-proADM's utility in enhancing early risk stratification for sepsis.
Main Methods:
- Prospective observational study of 120 sepsis patients in a North Indian tertiary hospital.
- Serum MR-proADM, PCT, and lactate measured on admission; SOFA and APACHE II scores calculated.
- Receiver operating characteristic (ROC) analysis used to determine prognostic accuracy.
Main Results:
- Nonsurvivors had significantly higher MR-proADM levels (2.48 ± 1.93 nmol/L) than survivors (1.43 ± 0.78 nmol/L).
- MR-proADM's ROC area was 0.767, comparable to SOFA (0.712) and superior to PCT (0.693) and APACHE II (0.699).
- Lactate showed a higher ROC area (0.807); MR-proADM >5.75 nmol/L indicated uniform mortality.
Conclusions:
- MR-proADM serves as a reliable adjunctive prognostic biomarker for sepsis.
- This biomarker can enhance early risk stratification when combined with established scores and markers.
