Proadrenomedullin, a useful tool for risk stratification in high Pneumonia Severity Index score community acquired pneumonia

Courtais, Caroline; Kuster, Nils; Dupuy, Anne‐Marie; Folschveiller, Margit; Jreige, Riad; Bargnoux, Anne-Sophie; Guiot, Julie; Lefebvre, Sophie; Cristol, Jean‐Paul; Sebbane, Mustapha

doi:10.1016/j.ajem.2012.07.017

Cited by 54 publications

(33 citation statements)

References 23 publications

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“…There are limited publications on the usefulness of MRproADM in the diagnosis and prognosis of sepsis and these have been most valuable for infections and sepsis of pulmonary origin (10,(43)(44)(45)(46)(47). The majority of the studies analyzed isolated MR-proADM levels in the emergency department (ED) and at admission; very few studies analyzed levels during evolution of the disease.…”

Section: Clinical Utility Of Mr-proadm Levels In Sepsis Patientsmentioning

confidence: 99%

“…The majority of the studies analyzed isolated MR-proADM levels in the emergency department (ED) and at admission; very few studies analyzed levels during evolution of the disease. Several studies make reference to the combination of this with other biomarkers, some of them conventionally used, such as CRP and PCT (44)(45)(46)48,49), and others more recently incorporated, such as pro-vasopressin (Pro-AVP), endothelin 1 (ET-1) or soluble urokinase-type plasminogen activator receptor (suPAR) (48,50,51).…”

Section: Clinical Utility Of Mr-proadm Levels In Sepsis Patientsmentioning

confidence: 99%

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New role of biomarkers: mid-regional pro-adrenomedullin, the biomarker of organ failure

et al. 2016

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Mid-regional pro-adrenomedullin (MR-proADM) has a good biomarker profile: its half-life is several hours, and its plasma concentrations can be determined in clinical practice, it is essentially irrelevant, but proportionally represents the levels and activity of adrenomedullin (ADM). ADM synthesis is widely distributed in tissues, including bone, adrenal cortex, kidney, lung, blood vessels and heart. Its fundamental biological effects include vasodilator, positive inotropic, diuretic, natriuretic and bronchodilator. It has been described high levels in septic patients, interacting directly with the relaxation of vascular tone, triggering hypotension of these patients. It is also found high levels in other diseases such as hypertension, heart failure, respiratory failure, renal failure, cirrhosis and cancer. MR-proADM has been identified as a prognostic marker, stratifying the mortality risk in patients with sepsis in emergency department (ED) and ICU. Evolutionary MR-proADM levels and clearance marker to the 2nd-5th days of admission help to determine the poor performance and the risk of mortality in patients with severe sepsis admitted to the ICU. The MR-proADM levels are more effective than procalcitonin (PCT) and C-reactive protein (CRP) levels to determine an unfavorable outcome and the risk of mortality in patients with sepsis admitted to the ICU. It has also proved useful in patients diagnosed with organ dysfunction of infectious etiology. MR-proADM levels are independent of the germ conversely it is related to the magnitude of organ failure and therefore severity. We consider advisable incorporating the MR-proADM the panel of biomarkers necessary for the diagnosis and treatment of critically ill patients admitted to the ICU with severe sepsis. The combined PCT and MR-proADM levels could represent a valid tool in the clinical practice to timely identify patients with bacterial infections and guide the diagnosis and treatment of sepsis and septic shock.

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Section: Clinical Utility Of Mr-proadm Levels In Sepsis Patientsmentioning

confidence: 99%

Section: Clinical Utility Of Mr-proadm Levels In Sepsis Patientsmentioning

confidence: 99%

New role of biomarkers: mid-regional pro-adrenomedullin, the biomarker of organ failure

et al. 2016

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“…mortality predictor in patients with a variety of underlying diseases presenting to the ED with acute dyspnea [20][21][22][23][24][25][26] and, especially, in patients with CAP [13,[27][28][29][30][31][32][33][34][35][36][37][38]; key studies are summarized in Table 1. Many of the dyspnea and CAP studies [20-23, 25-27, 29-31] had cohorts comprising > 25% of patients with COPD as a cormorbidity.…”

Section: Proadm In the Risk Assessment Of Patients With Other Pulmonamentioning

confidence: 99%

“…There exists a substantial observational literature regarding ProADM use as an all-cause mortality predictor in patients with sepsis [11][12][13][14][15][16][17][18][19], in patients with a variety of underlying diseases presenting to the emergency department (ED) with acute dyspnea [20][21][22][23][24][25][26], and especially in patients with community-acquired pneumonia (CAP) [13,[27][28][29][30][31][32][33][34][35][36][37][38].…”

Section: Introductionmentioning

confidence: 99%

The prognostic blood biomarker proadrenomedullin for outcome prediction in patients with chronic obstructive pulmonary disease (COPD): a qualitative clinical review

Schuetz¹,

Marlowe²,

Müeller

2015

Clinical Chemistry and Laboratory Medicine (CCLM)

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Plasma proadrenomedullin (ProADM) is a blood biomarker that may aid in multidimensional risk assessment of patients with chronic obstructive pulmonary disease (COPD). Co-secreted 1:1 with adrenomedullin (ADM), ProADM is a less biologically active, more chemically stable surrogate for this pluripotent regulatory peptide, which due to biological and ex vivo physical characteristics is difficult to reliably directly quantify. Upregulated by hypoxia, inflammatory cytokines, bacterial products, and shear stress and expressed widely in pulmonary cells and ubiquitously throughout the body, ADM exerts or mediates vasodilatory, natriuretic, diuretic, antioxidative, anti-inflammatory, antimicrobial, and metabolic effects. Observational data from four separate studies totaling 1366 patients suggest that as a single factor, ProADM is a significant independent, and accurate, long-term allcause mortality predictor in COPD. This body of work also suggests that combined with different groups of demographic/clinical variables, ProADM provides significant incremental long-term mortality prediction power relative to the groups of variables alone. Additionally, the literature contains indications that ProADM may be a global cardiopulmonary stress marker, potentially supplying prognostic information when cardiopulmonary exercise testing results such as 6-min walk distance are unavailable due to time or other resource constraints or to a patient's advanced disease. Prospective, randomized, controlled interventional studies are needed to demonstrate whether ProADM use in risk-based guidance of site-of-care, monitoring, and treatment decisions improves clinical, qualityof-life, or pharmacoeconomic outcomes in patients with COPD.

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“…Copeptin performed similarly to the PSI and ATS/IDSA minor criteria and was better in predicting early instability and mortality than other biomarkers, including CRP, PCT, leukocyte count, and mid-regional proadrenomedullin (MR-proADM) [29]. In other studies, however, high MRproADM has been noted to carry a prognostic value not only in predicting mortality in patients with PSI class IV and V but also in predicting severity of illness and likelihood of complications, irrespective of the etiology [30][31][32].…”

Section: Biomarkers In Capmentioning

confidence: 90%

Management of community-acquired pneumonia

Ehsan¹,

Metersky

2013

Curr Respir Care Rep

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This article summarizes recent literature related to community-acquired pneumonia (CAP), which continues to represent one of the most common causes of morbidity and mortality throughout the world, especially in the elderly. The impact is even more striking if we take healthcare costs into account. Patients with CAP usually have other comorbidities which not only increase mortality in this group but also add further to its economic burden. Patients with COPD, preexisting cardiac disease, and diabetes are particularly at higher risk for developing more severe pneumonia. New diagnostic modalities, including ultrasonography, are being used more commonly in clinical practice. Procalcitonin levels can be used to identify bacterial pneumonia and to de-escalate antibiotic therapy, resulting in fewer days on antibiotics. Other biomarkers have been used in studies to stratify patients by risk. Guideline-concordant regimens including atypical coverage, and macrolides in particular, appear to provide benefit. More recent data suggest the need for careful screening of patients for cardiovascular risk factors prior to initiating macrolides and fluoroquinolones.

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Proadrenomedullin, a useful tool for risk stratification in high Pneumonia Severity Index score community acquired pneumonia

Cited by 54 publications

References 23 publications

New role of biomarkers: mid-regional pro-adrenomedullin, the biomarker of organ failure

New role of biomarkers: mid-regional pro-adrenomedullin, the biomarker of organ failure

The prognostic blood biomarker proadrenomedullin for outcome prediction in patients with chronic obstructive pulmonary disease (COPD): a qualitative clinical review

Management of community-acquired pneumonia

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