Prognostic value of pro-atrial natriuretic peptide, pro-adrenomedullin, and pro-endothelin-1 in critically ill patients

Introduction

Systemic inflammation is accompanied by cardiovascular dysfunction. Prohormones of cardiovascular active mediators may therefore add important information to the clinical status of these patients. The goal of this study was to describe the prognostic value of three different prohormones in an ICU setting.

Methods

Citrate plasma samples of 185 patients with either severe sepsis/septic shock (n = 120) or systemic inflammatory response syndrome (SIRS; n = 65) after coronary bypass surgery have been obtained on admission to the ICU. Midregional pro-atrial natriuretic peptide (MR-proANP), midregional pro-adrenomedullin (MR-proADM), and C-terminal pro-endothelin-1 (CT-proET-1) have been measured by an immunoassay (BRAHMS AG, Germany). The prognostic value for ICU survival was estimated by the area under the curve (AUC) of the receiver–operating characteristics (ROC).

Results

The mean age was 63.5 years. The mortality rate was 27% at a mean APACHE II score of 17.5. AUC values and 95% CIs are presented in Table 1. The AUC of the APACHE II score to predict survival in this study was 0.70 (0.61; 0.80).

Table 1 (abstract P197)

Conclusion

Elevation of all three parameters is significantly associated with a poor prognosis in critically ill patients. Outcome prediction is similar to the APACHE II score.