Prognostic Role of Serum Adrenomedullin in Patients with Ventilator Associated Pneumonia

Abstract

Objective: Ventilator associated pneumonia is a common type of sepsis that occurs to about 9–27% of all mechanically ventilated patients and 20–50% of them develop septic shock. Several clinical, laboratory, and radiological methods have been used for diagnosing VAP. Adrenomedullin (ADM) has been found to be elevated in the plasma of septic patients. The study aim was to explore the prognostic role of ADM in the VAP patients. Design: A prospective observational study. Setting: Intensive Care Department of Alexandria University Hospitals. Patients: A total of 140 patients with proven VAP after medical ICU admission were consecutively enrolled. Methods: APACHE II score, SOFA score, CRP, lactate, and serum ADM were measured at day 0 of VAP diagnosis and 5 days later. The results were correlated with the outcomes of patients. Results: APACHE II, lactate, and serum ADM on day 0 could predict an unfavorable outcome. ADM prediction power was significantly higher than APACHE II and lactate. Day 5 readings of all tested parameters could predict occurrence of the unfavorable outcome. ADM on day 0 showed the highest sensitivity (96.25%). Conclusions: Serum adrenomedullin when measured at days 0 and 5 of VAP diagnosis may serve as an early predictor of unfavorable outcome.

Clinical Potential of Adrenomedullin Signaling in the Cardiovascular System

“…154 A recent study reported that serum AM levels are also a promising predictive marker in the assessment of ventilator-associated pneumonia diagnosis. 155 Of note, it has long been demonstrated that AM also has an antimicrobial role, participating in the prevention of local infection acting synergistically with the immune response (Figure 2). 156 Interestingly, antimicrobial effects of AM seem to be independent from its classical signaling pathway.…”

“…154 A recent study reported that serum AM levels are also a promising predictive marker in the assessment of ventilator-associated pneumonia diagnosis. 155…”

Leveraging Integrated RNA Sequencing to Decipher Adrenomedullin’s Protective Mechanisms in Experimental Bronchopulmonary Dysplasia

“…Its expression is up-regulated in response to various stimuli such as hypoxia, inflammation, and mechanical stress [ 19 , 21 ]. Adm has been implicated in several pathological conditions, including cardiovascular diseases [ 20 , 22 , 23 , 24 , 25 ], pulmonary disorders [ 26 , 27 , 28 , 29 , 30 ], gastrointestinal disorders [ 31 , 32 ], sepsis [ 33 , 34 , 35 , 36 ], cancer [ 20 , 32 , 37 , 38 ], and disorders associated with pregnancy [ 39 , 40 , 41 , 42 ]. Since Adm is highly enriched in the lungs, its expression is influenced by inflammation, and the peptide plays a vital role in maintaining endothelial cell homeostasis [ 43 , 44 , 45 ]; Adm may play a pathogenic role in inflammatory lung disorders such as BPD.…”