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Licensed Unlicensed Requires Authentication Published by De Gruyter August 29, 2018

Mid-regional pro-adrenomedullin predicts poor outcome in non-selected patients admitted to an intensive care unit

  • Chiara Bellia , Luisa Agnello , Bruna Lo Sasso , Giulia Bivona , Maurizio Santi Raineri , Antonino Giarratano and Marcello Ciaccio EMAIL logo

Abstract

Background

Mortality risk and outcome in critically ill patients can be predicted by scoring systems, such as APACHE and SAPS. The identification of prognostic biomarkers, simple to measure upon admission to an intensive care unit (ICU) is an open issue. The aim of this observational study was to assess the prognostic value of plasma mid-regional pro-adrenomedullin (MR-proADM) at ICU admission in non-selected patients in comparison to Acute Physiology and Chronic Health Evaluation II (APACHEII) and Simplified Acute Physiology Score II (SAPSII) scores.

Methods

APACHEII and SAPSII scores were calculated after 24 h from ICU admission. Plasma MR-proADM levels were measured by TRACE-Kryptor on admission (T0) and after 24 h (T24). The primary endpoint was intra-hospital mortality; secondary endpoint was length of stay (LOS).

Results

One hundred and twenty-six consecutive non-selected patients admitted to an ICU were enrolled. Plasma MR-proADM levels were correlated with LOS (r=0.28; p=0.0014 at T0; r=0.26; p=0.005 at T24). Multivariate analysis showed that T0 MR-proADM was a significant predictor of mortality (odds ratio [OR]: 1.27; 95% confidence interval [95%CI]: 1.03–1.55; p=0.022). Receiver operating characteristic curves analysis revealed that MR-proADM on ICU admission identified non-survivors with high accuracy, not inferior to the one of APACHEII and SAPSII scores (area under the curve [AUC]: 0.71; 95%CI: 0.62–0.78; p=0.0002 for MR-proADM; AUC: 0.71; 95%CI: 0.62–0.79; p<0.0001 for APACHEII; AUC: 0.8; 95%CI: 0.71–0.87; p<0.0001 for SAPSII).

Conclusions

Our findings point out a role of MR-proADM as a prognostic tool in non-selected patients in ICUs being a reliable predictor of mortality and LOS and support its use on admission to an ICU to help the management of critically ill patients.


Corresponding author: Professor Marcello Ciaccio, MD, PhD, Department of Biopathology and Medical Biotechnologies, Section of Clinical Biochemistry and Clinical Molecular Medicine, Policlinico P. Giaccone, University of Palermo, Via del Vespro, 129, CAP 90127, Palermo, Italy, Phone: +39 091 23865701, Fax: +39 091 655 3275
aChiara Bellia and Luisa Agnello contributed equally to this work.

Acknowledgments

Thermo Fisher Scientific provided the reagents for MR-proADM measurement and provide support for statistical analysis.

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: None declared.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

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Received: 2018-06-21
Accepted: 2018-07-21
Published Online: 2018-08-29
Published in Print: 2019-03-26

©2019 Walter de Gruyter GmbH, Berlin/Boston

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