Prognostic Role of Mid-Regional Proadrenomedullin in Patients Undergoing Emergency Laparotomy: An Exploratory Study

Our primary objective was to determine the ability of mid-regional proadrenomedullin (MR-proADM) levels to predict outcomes, i.e., mortality and clinical cure within 30 days in post-laparotomy patients. The secondary objective was to correlate MR-proADM with other markers of sepsis, such as procalcitonin (PCT) and lactate, and to determine the ability of MR-proADM levels to predict the presence or absence of sepsis on preoperative days 3, 5, and 7 in post-laparotomy patients.  Methods: This was a single-center prospective pilot observational study. Patients ≥18 years of age who underwent emergency laparotomy (EL) under general anesthesia at a tertiary care hospital between January 2022 and July 2023 were enrolled. MR-proADM, lactate, PCT, and sequential organ failure assessment (SOFA) scores were measured pre-operatively and on days 3, 5, and 7. Detection of sepsis, clinical cure, and 30-day all-cause mortality were ascertained.

MR-proADM demonstrated statistically significant correlation with PCT (p<0.001) at all time points, the SOFA score at preoperative, day 5, and day 7, and lactate on day 7 (p<0.001). MR-proADM levels were higher on days 5 and 7 in patients who failed to achieve clinical cure (p=0.0003 and 0.0004, respectively). At all time points, the discriminatory ability of MR proADM to distinguish sepsis from non-sepsis was good. A comparison of MR-proADM levels in patients with 30-day all-cause mortality was performed. The non-survivors had significantly elevated MR-proADM levels at all time points.

MR-proADM is a valuable biomarker that correlates strongly with lactate, PCT, and the SOFA score and can help detect sepsis. Persistently higher values were associated with absence of clinical cure and 30-day all-cause mortality in patients undergoing EL.