MR-proADM and MR-proANP levels in patients with acute pulmonary embolism

Abstract

Summary Background The aim of this study was to determine levels of Mid-regional Pro-adrenomedullin (MR-proADM) and Mid-regional Pro-atrial Natriuretic Peptide (MR-proANP) in patients with acute pulmonary embolism (PE), the relationship between these parameters and the risk classification in addition to determining the relationship between 1- and 3-month mortality. Methods 82 PE patients and 50 healthy control subjects were included in the study. Blood samples for MR-proANP and MR-proADM were obtained from the subjects prior to the treatment. Risk stratification was determined according to sPESI (Simplified Pulmonary Embolism Severity Index). Following these initial measurements, cases with PE were assessed in terms of all causative and PE related mortalities. Results The mean serum MR-proANP and MR-proADM levels in acute PE patients were found to be statistically higher compared to the control group (p < 0.001, p < 0.01; respectively) and statistically significantly higher in high-risk patients than low-risk patients (p < 0.01, p < 0.05; respectively). No statistical difference was determined in high-risk patients in case of sPESI compared to low-risk patients while hospital mortality rates were higher. It was determined that the hospital mortality rate in cases with MR-proANP ≥ 123.30 pmol/L and the total 3-month mortality rate in cases with MR-proADM ≥ 152.2 pg/mL showed a statistically significant increase. Conclusions This study showed that MR-proANP and MR-proADM may be an important biochemical marker for determining high-risk cases and predicting the mortality in PE patients and we believe that these results should be supported by further and extensive studies.

Circulating MR-proADM levels, as an indicator of endothelial dysfunction, for early risk stratification of mid-term mortality in COVID-19 patients

“…The prognostic value of MR-proADM has been previously reported in non-infectious diseases, such as acute pulmonary embolism [Öner et al, 2020] , heart failure [Maisel et al, 2010] and myocardial infarction [Horiuchi et al, 2020] , and also in infectious diseases, including acquired community pneumonia [ Huang et al, 2009 ; Legramante et al, 2017 ], independently of its etiology [Bello et al, 2012] , and sepsis [ Bernal-Morell et al; 2018 ; Charles et al, 2017; Andaluz-Ojeda et al; 2017 ]. MR-proADM has been showed as an useful tool to assess the overall severity of the host response; hence, it could accurately identify infected patients requiring admission into the ICU [Baldirà et al; 2020] and the likelihood of further disease progression in patients with suspected infection presenting to the ED, in order to either initiate, escalate or intensify early treatment strategies, or identify patients suitable for safe out-patient treatment [Saeed et al; 2019] .…”

Mid-regional pro-atrial natriuretic peptide and copeptin as indicators of disease severity and therapy response in CTEPH

“…An MR-proANP level of 120 pmol·L −1 was shown to rule out acute heart failure with a sensitivity >90% [ 29 ]. In acute pulmonary embolism [ 17 ] and different forms of pulmonary hypertension [ 15 , 16 , 23 ], the reported median MR-proANP level ranges from 105 to 201 pmol·L −1 and was 130 pmol·L −1 in a small subcohort of seven CTEPH patients [ 15 ]. The median MR-proANP level of 156 (91–246) pmol·L −1 in our cohort is comparable to these data and reflects chronic cardiac stress in the majority of CTEPH patients.…”

“…Published data demonstrate the superiority of MR-proANP compared with established biomarkers for predicting an adverse outcome in chronic heart failure [ 13 ], pulmonary embolism [ 17 ] and pulmonary hypertension [ 16 ]. In heart failure, the additive measurement of MR-proANP improved disease detection and risk stratification compared to a sole measurement of brain natriuretic peptides [ 35 , 36 ].…”

“…Their higher plasma stability allows a valid equimolar measurement as surrogates for the mature proteins. ANP and MR-proANP levels correlate with disease severity and outcome in heart failure [ 13 ], acute pulmonary embolism [ 14 ] and pulmonary hypertension [ 15 – 17 ]. Copeptin gained importance in the diagnostic work-up of acute cardiovascular disease, particularly acute coronary syndrome [ 18 ].…”

“…Their higher plasma stability allows a valid equimolar measurement as surrogates for the mature proteins. ANP and MR-proANP levels correlate with disease severity and outcome in heart failure [13], acute pulmonary embolism [14] and pulmonary hypertension [15][16][17].…”