Clinical value of pro-atrial natriuretic peptide and pro-adrenomedullin to predict severity and outcome in sepsis

Abstract

Objective To evaluate the prognostic value of pro-atrial natriuretic peptide (pro-ANP) and pro-adrenomedullin (pro-ADM) levels in a cohort of medical intensive care patients, comparing them with other biomarkers and physiological score. Methods We performed prospective trial, according to the international criteria, 51 critically ill patients admitted to the intensive care unit were classified into four groups: systemic inflammatory response syndrome (SIRS) (n=25), sepsis (n=12), severe sepsis (n=9) and septic shock (n=5). The levels of plasma pro-ANP and pro-ADM were measured in each group, and compared with the other biomarkers(i. e. procalcitonin, C-reactive protein and IL-6) and the acute physiology and chronic health evaluation(APACHE)Ⅱ score. Pro- ANP and pro- ADM were detected using a new sandwich iminunoassay. Results On admission, median pro - ANP pro - ADM levels on admission (μg/L) were 87.22 (32.60) and 0.34(0.21) in patients with systemic inflammatory response syndrome, 533.30(119.47) and 2.23 (0.86) in those with sepsis, 1098.73 (236.63) and 4.57 (2.01) in those with severe sepsis, 1933.94 (417.31) and 8.21 (3.27) in patients with septic shock. With the increasing severity of the disease, the levels of pro - ANP, pro - ADM gradually increased. On admission, circulating pro-ANP and pro-ADM levels in patients with sepsis, severe sepsis, or septic shock were significantly highei in nonsurvivors than in survivors(P<0.05) . In a receiver operating curve analysis of survival of patients with sepsis, the area under the curve (AUC) for pro - ANP, pro - ADM were 0.89 and 0.87, which was similar to the AUCs for PCT(0.81), acute physiology and chronic health evaluation Ⅱ score (0.81). Conclusions Pro-ANP and pro-ADM is a valuable tool for prognostic and individual risk stratification of sepsis patients. Key words: Pro-atrial natriuretic peptide; Pro-adrenomedullin; Sepsis; Prognosis