The use of mid-regional proadrenomedullin to identify disease severity and treatment response to sepsis - a secondary analysis of a large randomised controlled trial

Elke, Gunnar; Bloos, Frank; Wilson, Darius Cameron; Brunkhorst, Frank Martin; Briegel, Josef; Reinhart, Konrad; Loeffler, Markus; Kluge, Stefan; Nierhaus, Axel; Jaschinski, Ulrich; Moerer, Onnen; Weyland, Andreas; Meybohm, Patrick

doi:10.1186/s13054-018-2001-5

Critical Care

Table 2 Survival analysis for 7-day, 90-day, ICU and hospital mortality

From: The use of mid-regional proadrenomedullin to identify disease severity and treatment response to sepsis - a secondary analysis of a large randomised controlled trial

					Univariate Cox regression				Multivariate Cox regression
	Biomarker or clinical score	Patients (N)	Mortality (N)	AUROC	LR χ²	C-index	HR IQR (95% CI)	p value	LR χ²	C-index	HR IQR (95% CI)
7-day mortality	MR-proADM	1037	131	0.72	71.6	0.71	3.3 (2.4–4.3)	<0.001	82.1	0.73	3.4 (2.5–4.6)
	PCT	1038	131	0.58	9.7	0.58	1.5 (1.2–2.0)	0.002	28.4	0.64	1.6 (1.2–2.1)
	CRP	943	111	0.55	1.2	0.55	1.1 (0.9–1.4)	0.284	16.6	0.62	1.2 (0.9–1.4)
	Lactate	1074	135	0.72	86.0	0.71	3.1 (2.4–3.9)	<0.001	99.1	0.73	3.1 (2.4–4.0)
	SOFA	1059	130	0.63	25.5	0.63	1.7 (1.4–2.0)	<0.001	41.0	0.67	1.7 (1.4–2.1)
	SAPS II	1085	135	0.66	38.5	0.66	1.8 (1.5–2.2)	<0.001	50.1	0.67	1.8 (1.5–2.2)
	APACHE II	1085	135	0.63	24.4	0.63	1.7 (1.4–2.1)	<0.001	37.8	0.65	1.7 (1.4–2.1)
90-day mortality	MR-proADM	1000	379	0.71	146.2	0.68	2.7 (2.3–3.2)	<0.001	194.1	0.71	2.4 (2.0–2.8)
	PCT	1000	379	0.55	11.8	0.55	1.3 (1.1–1.5)	0.001	113.5	0.65	1.3 (1.1–1.5)
	CRP	909	348	0.51	0.2	0.51	1.0 (0.9–1.2)	0.664	92.3	0.64	1.1 (0.9–1.2)
	Lactate	1037	399	0.64	83.2	0.63	2.0 (1.7–2.3)	<0.001	168.8	0.68	1.9 (1.6–2.2)
	SOFA	1021	388	0.62	48.1	0.61	1.5 (1.4–1.7)	<0.001	143.7	0.67	1.5 (1.3–1.7)
	SAPS II	1045	399	0.66	81.1	0.64	1.7 (1.5–1.9)	<0.001	144.4	0.67	1.5 (1.3–1.7)
	APACHE II	1045	399	0.67	86.4	0.64	1.8 (1.6–2.1)	<0.001	146.8	0.67	1.6 (1.4–1.8)
ICU mortality	MR-proADM	1023	264	0.73	136.4	0.73	4.0 (3.1–5.2)	<0.001	158.3	0.75	3.7 (2.8–4.9)
	PCT	1024	264	0.58	18.0	0.58	1.6 (1.3–2.0)	<0.001	73.0	0.67	1.6 (1.3–2.1)
	CRP	928	237	0.54	2.5	0.54	1.1 (1.0–1.3)	0.111	51.4	0.65	1.2 (1.0–1.4)
	Lactate	1059	277	0.66	75.2	0.66	2.4 (2.0–3.0)	<0.001	115.5	0.71	2.4 (1.9–2.9)
	SOFA	1044	270	0.64	48.6	0.64	1.8 (1.5–2.2)	<0.001	95.2	0.69	1.8 (1.5–2.2)
	SAPS II	1070	277	0.65	58.7	0.65	1.9 (1.6–2.3)	<0.001	91.2	0.68	1.8 (1.5–2.2)
	APACHE II	1070	277	0.66	62.5	0.66	2.1 (1.7–2.6)	<0.001	91.6	0.69	1.9 (1.5–2.3)
Hospital mortality	MR-proADM	980	323	0.73	152.0	0.74	4.0 (3.1–5.2)	<0.001	186.8	0.76	3.6 (2.7–4.6)
	PCT	981	323	0.57	15.0	0.57	1.5 (1.2–1.9)	<0.001	96.2	0.68	1.5 (1.2–1.9)
	CRP	891	299	0.52	0.9	0.52	1.1 (0.9–1.3)	0.348	76.0	0.67	1.1 (1.0–1.3)
	Lactate	1016	342	0.66	77.8	0.66	2.4 (2.0–2.9)	<0.001	146.2	0.72	2.3 (1.9–2.9)
	SOFA	1001	333	0.63	41.3	0.63	1.7 (1.4–2.0)	<0.001	118.9	0.70	1.7 (1.4–2.0)
	SAPS II	1027	342	0.65	59.1	0.65	1.9 (1.6–2.2)	<0.001	115.9	0.69	1.7 (1.4–2.0)
	APACHE II	1027	342	0.67	76.7	0.67	2.2 (1.9–2.7)	<0.001	127.1	0.71	1.9 (1.6–2.4)

All multivariate p values <0.001, apart from PCT and CRP for 7-day mortality (0.002 and 0.084, respectively)
APACHE II Acute Physiological and Chronic Health Evaluation II score, CI confidence interval, CRP C-reactive protein, HR hazard ratio, IQR interquartile range, MR-proADM mid-regional proadrenomedullin, N number, PCT procalcitonin, SAPS I I Simplified Acute Physiological Score II, SOFA Sequential Organ Failure Assessment score, LR likelihood ratio

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