Pro-adrenomedullin as prognostic biomarker in the sepsis

Introduction

Measurement of biomarkers is a potential approach to early assessment and prediction of mortality in septic patients. The purpose of this study was to ascertain the prognostic value of pro-adrenomedullin (pADM), measured in all patients admitted to the ICU of our hospital with a diagnosis of severe sepsis or septic shock during 1 year.

Methods

A cohort study of 117 patients >18 years with severe sepsis according to the Surviving Sepsis Campaign, in an ICU of a university hospital. Demographic, clinical parameters and pADM, C-reactive protein and procalcitonin were studied during 1year. Descriptive and comparative statistical analysis was performed using the statistical software packages Statistica Stat Soft Inc 7.1 and MedCalc 9.2.1.0.

Results

We analyzed 117 consecutive episodes of severe sepsis (15%) or septic shock (85%) in the ICU. The median age of the patients was 64 (interquartile range, 53 to 72) years; the main sources of infection were respiratory tract (46%) and intra-abdomen (21%). The 28-day mortality was 32.5%. The profile of death patients had a significantly higher average age (64.7 vs. 57.6 years; P = 0.024), as well as clinical severity scores, APACHE II (26.6 vs. 23; P = 0.006) and SOFA (11.6 vs. 89.2; P < 0.001). Kaplan-Meier survival analysis was significant. P = 0.0017 for patients with pADM <1.2 nmol/l. Cox regression analysis also showed statistical significance (P = 0.0033) and a likelihood ratio = 1.18 per each 1 nmol/l increase in pADM.

Conclusion

The protein pADM is an important prognostic biomarker of survival when measured on admission of septic patients to the ICU.