Postoperative Pro-Adrenomedullin Levels Predict Mortality in Thoracic Surgery Patients

Schoe, Abraham; Schippers, Emile F.; Struck, Joachim; Ebmeyer, Stefan; Klautz, Robert J.M.; Jonge, Evert de; Dissel, Jaap T. van

doi:10.1097/ccm.0000000000000709

Cited by 20 publications

(5 citation statements)

References 33 publications

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“…Mid-regional proadrenomedullin (MR-proADM) is a peptide generated by multiple tissues in order to stabilise the microcirculation and protect against endothelial permeability [ 6 – 11 ], both of which are widely acknowledged to play a significant role in the pathophysiological host response to sepsis [ 12 , 13 ]. Indeed, MR-proADM levels are rapidly induced during the initial stages of sepsis development following burns [ 14 ] and neurological disorders [ 15 ], in response to invasive fungal infections in patients with septic shock [ 16 ], and in other conditions such as lower respiratory tract infections [ 17 – 19 ], lung transplantation [ 20 ] and thoracic surgery [ 21 ]. Thus, MR-proADM may be of significant clinical utility in the early risk stratification of patients with sepsis.…”

Section: Introductionmentioning

confidence: 99%

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

Elke¹,

Bloos

Wilson

et al. 2018

Crit Care

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BackgroundThis study assessed the ability of mid-regional proadrenomedullin (MR-proADM) in comparison to conventional biomarkers (procalcitonin (PCT), lactate, C-reactive protein) and clinical scores to identify disease severity in patients with sepsis.MethodsThis is a secondary analysis of a randomised controlled trial in patients with severe sepsis or septic shock across 33 German intensive care units. The association between biomarkers and clinical scores with mortality was assessed by Cox regression analysis, area under the receiver operating characteristic and Kaplan-Meier curves. Patients were stratified into three severity groups (low, intermediate, high) for all biomarkers and scores based on cutoffs with either a 90% sensitivity or specificity.Results1089 patients with a 28-day mortality rate of 26.9% were analysed. According to the Sepsis-3 definition, 41.2% and 58.8% fulfilled the criteria for sepsis and septic shock, with respective mortality rates of 20.0% and 32.1%. MR-proADM had the strongest association with mortality across all Sepsis-1 and Sepsis-3 subgroups and could facilitate a more accurate classification of low (e.g. MR-proADM vs. SOFA: N = 265 vs. 232; 9.8% vs. 13.8% mortality) and high (e.g. MR-proADM vs. SOFA: N = 161 vs. 155; 55.9% vs. 41.3% mortality) disease severity. Patients with decreasing PCT concentrations of either ≥ 20% (baseline to day 1) or ≥ 50% (baseline to day 4) but continuously high MR-proADM concentrations had a significantly increased mortality risk (HR (95% CI): 19.1 (8.0–45.9) and 43.1 (10.1–184.0)).ConclusionsMR-proADM identifies disease severity and treatment response more accurately than established biomarkers and scores, adding additional information to facilitate rapid clinical decision-making and improve personalised sepsis treatment.Electronic supplementary materialThe online version of this article (10.1186/s13054-018-2001-5) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

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

Elke¹,

Bloos

Wilson

et al. 2018

Crit Care

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“…A preoperative value of 0.87 nmol/L in the pilot study of our group to predict the need for POS [35]; A preoperative value of 0.85 nmol/L in the study by Golubović et al to predict postoperative mortality in abdominal surgery [36]; A preoperative value of 0.77 ± 0.37 nmol/L in the study of Egyed et al [37]; A preoperative value of 1.3 nmol/L in the study referring to the prognostic capacity of mortality after TAVI [38]; A postoperative value of 3.2 nmol/L in the study for the prediction of mortality in the postoperative period of cardiac surgery [39].…”

Section: Discussionmentioning

confidence: 99%

Usefulness of Preoperative Determination of Serum MR-ProAdrenomedullin Levels to Predict the Need for Postoperative Organ Support in Abdominal Oncological Surgery

Rueda

Roca

Hernández

et al. 2023

JPM

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The need for postoperative organic support is associated with patient outcomes. Biomarkers may be useful for detecting patients at risk. MR-ProADM is a novel biomarker with an interesting profile that can be used in this context. The main objective of this study was to verify whether there was an association between the preoperative serum levels of MR-ProADM and the need for organic support after elective abdominal cancer surgery, and to determine the preoperative MR-ProADM value that predicts the need for postoperative organic support. This was a multicenter prospective observational study conducted by four tertiary hospitals in Spain between 2017 and 2018. Plasma samples were collected for the quantification of MR-ProADM from adults who underwent major abdominal surgery during 2017–2018. The primary outcome was the need for organic support in the first seven postoperative days and its association with the preoperative levels of MR-ProADM, and the secondary outcome was the preoperative levels of MR-ProADM in the study population. This study included 370 patients with a mean age of 67.4 ± 12.9 years. Seventeen percent (63 patients) required some postoperative organic support measures in the first week. The mean preoperative value of MR-ProADM in patients who required organic support was 1.16 ± 1.15 nmol/L. The AUC-ROC of the preoperative MR-ProADM values associated with the need for organic support was 0.67 (95% CI: 0.59–0.75). The preoperative MR-ProADM value, which showed the best compromise in sensitivity and specificity for predicting the need for organic support, was 0.70 nmol/L. The negative predictive value was 91%. A multivariate analysis confirmed that a preoperative level of MR-ProADM ≥ 0.70 nmol/L is an independent factor associated with risk of postoperative organic support (OR 2, 6). Elevated preoperative MR-ProADM levels are associated with the need for postoperative organic support. Therefore, MR-ProADM may be a useful biomarker for perioperative risk assessment.

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“…It has been examined whether a panel of biomarkers (PCT, MR-proADM, CT-pro-endothelin-1, CT-pro-arginine vasopressin, and MR-pro-ANP), each of them separately or using the Acute Physiology and Chronic Health Evaluation IV score, has a greater significance in the prediction of intrahospital mortality. It has been shown that MR-proADM has the greatest significance in the first 6 to 18 hours after entering the ICU, even when its significance has been compared to the Acute Physiology and Chronic Health Evaluation IV score in elective cardiosurgery (17).…”

Section: Discussionmentioning

confidence: 99%

Proadrenomedulin as a Predictor of Mortality in Major Non-Cardiac Surgery

Golubović¹,

Cvetanović²,

Jovanović³

et al. 2017

amm

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Anesthesiologists are in daily contact with patients who are preparing for noncardiosurgical interventions, and who have an increased risk of developing cardiovascular complications in the perioperative period. Less than 1% of patients develop perioperative IM, however the mortality rate for this complication ranges from 30% to 50%. The first step is the identification of patients in whom the cardiovascular system is a potential source of complications during and after surgery. The risk of perioperative complications depends on the condition of the patient prior to the intervention, prevalence of comorbidities and the extent, urgency and duration of the operation. The modern concept of preoperative preparation of patients for major non-cardiac surgery is now based on the measurement and interpretation of various biomarkers as prognosticators of perioperative cardiovascular complications and fatal outcomes. For these purposes, high-performance natriuretic peptides and cardiac troponins are used. There is evidence that the levels of cardiac-specific troponins, and especially highsensitivity troponin T(hs-TnT), have been elevated in patients with various cardiovascular diseases such as: cardiac insufficiency and coronary disease, reflecting in this way a lower degree of damage that can be of significant benefit in the preoperative assessment of cardiovascular morbidity and mortality in elective, major non-cardiac surgery. Although various natriuretic peptides have been in the greatest focus of interest as prognostic biomarkers over the past decade, the interest in other circulating biomarkers, such as midregional proadrenomedulin (MR-pro ADM), has been growing in recent years. This new biomarker represents a stable circulating peptide, and is the prohormone of adrenomedulin, a hormone responsible for regulating the volume of circulating fluid and electrolyte homeostasis. Elevated levels of this biomarker are seen in heart failure of different etiologies and can therefore serve as a useful prognostic marker of the development of perioperative cardiovascular complications in patients with different cardiovascular comorbid conditions.

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Postoperative Pro-Adrenomedullin Levels Predict Mortality in Thoracic Surgery Patients

Abstract: In elective cardiac surgery, MR-pro-adrenomedullin measured between 6 and 18 hours after admission to the ICU is a better predictor of hospital mortality in comparison with the Acute Physiology and Chronic Health Evaluation IV score.

Cited by 20 publications

References 33 publications

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

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

Usefulness of Preoperative Determination of Serum MR-ProAdrenomedullin Levels to Predict the Need for Postoperative Organ Support in Abdominal Oncological Surgery

Proadrenomedulin as a Predictor of Mortality in Major Non-Cardiac Surgery

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