ORIGINAL ARTICLE   Free

Minerva Anestesiologica 2019 April;85(4):366-75

DOI: 10.23736/S0375-9393.18.12687-3

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Plasma levels of mid-regional pro-adrenomedullin in sepsis are associated with risk of death

Francisco VALENZUELA-SÁNCHEZ ¹ ✉, Blanca VALENZUELA-MÉNDEZ ^{2, 3}, Rafael BOHOLLO de AUSTRIA ¹, Juan F. RODRÍGUEZ-GUTIÉRREZ ⁴, Ángel ESTELLA-GARCÍA ¹, Laura FERNÁNDEZ-RUIZ ¹, María Á. GONZÁLEZ-GARCÍA ⁵, Jordi RELLO ⁶

¹ Department of Critical Care Medicine, University Hospital SAS of Jerez, Jerez de la Frontera, Cadiz, Spain; ² Department of Gynecology and Obstetrics, University Hospital Germans Trias i Pujol, Barcelona, Spain; ³ Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain; ⁴ Department of Hematology, University Hospital SAS of Jerez, Jerez de la Frontera, Cadiz, Spain; ⁵ Clinical Analysis Laboratory, University Hospital SAS of Jerez, Jerez de la Frontera, Cadiz, Spain; ⁶ CIBERES, Vall d'Hebron Institute of Research (VHIR), Autonomous University of Barcelona, Barcelona, Spain

BACKGROUND: Identifying Intensive Care Unit (ICU) patients with sepsis and predicting the risk of death are unmet clinical needs.
METHODS: Prospective observational single-center study of 120 consecutive ICU patients with suspected severe sepsis at Jerez Hospital. Epidemiological, clinical, laboratory data and MR-proADM, Procalcitonin (PCT) and C-reactive protein (CRP) levels were recorded at ICU admission and follow-up.
RESULTS: At ICU discharge, 104 patients were diagnosed with severe sepsis and 39 died. Plasma MR-proADM was highly indicative of sepsis: 4.05 nmol/L vs. of 0.309 nmol/L (P<0.001), with area under the ROC curve (AUC-ROC) was 0.947. At 48 hours following admission, the median MR-proADM levels in surviving sepsis patients fell to 1.65 nmol/L but remained higher in the non-survivors (2.475 nmol/L) (P=0.04). On day 5 the levels fell to 1.36 nmol/L in surviving sepsis patients vs. 3.42 nmol/L in the non-survivors (P<0.001). On day 5 the survivors showed greater MR-proADM clearance (62.7% vs. 21.2%). The AUC-ROC on day 5 was 0.825, PCT 0.725 and CRP 0.700. The AUC-ROC to MR-proADM clearance on day 5 was 0.734. In a multivariable model, MR-proADM levels at 48 hours and on day 5 and clearance on day 5 following admission were statistically significant predictive factors of mortality.
CONCLUSIONS: In clinical practice, in ICU patients admitted with SIRS and organ dysfunction, an MR-proADM cut-off point of 1.425 nmol/L helps to identify those with sepsis. An MR-proADM value above 5.626 nmol/L 48 hours after admission was associated with a high risk of death.

KEY WORDS: Adrenomedullin; Mid-regional pro-adrenomedullin, human; Biomarkers; Sepsis; Prognosis; Shock, septic