Midregional proadrenomedullin in correlation with Sequential Organ Failure Assessment score and Acute Physiology and Chronic Health Evaluation II score in sepsis

Abstract

Introduction The early diagnosis of sepsis plays a central role in patient management. Many mediators have been proposed to be the cause of sepsis. In the present study, we investigate the role of plasma proadrenomedullin (proADM) levels in the diagnosis of sepsis, and to estimate its value as a prognostic marker of mortality. Also, the prognostic value of proADM was compared with those of C-reactive protein, serum lactate, Sequential Organ Failure Assessment, and Acute Physiology and Chronic Health Evaluation II scores. Patients and methods This is a prospective cohort study done between March 2015 and January 2016 on 10 healthy individuals and 30 patients admitted with a new diagnosis of sepsis or developed septic shock during their ICU stay in Cairo University Hospitals. All included patients were followed until hospital discharge or death. Our patients were divided into two groups (survivors and nonsurvivors). Results In the analyzed cohort, a total of 30 septic patients were enrolled. The mean age was 57.1±15.9 years; the overall nonsurvivors were 19 (63.3%) patients. ProADM showed the highest area under the curve (0.89) as compared with the rest of the biomarkers (P<0.0001). ProADM levels were directly proportional to Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment score (r=0.547; P=0.002 and r=0.549; P=0.002, respectively). ProADM levels were negatively correlated with mean arterial pressure on admission (r=−0.472; P=0.009) with also a strong association with vasopressor therapy (P<0.0001). ProADM levels at days 3 and 4 in patients required mechanical ventilation (MV) were significantly higher than patients without MV (141.1±32.4 and 154.4±33.5 pmol/l compared with 100.8±18.3 and 94±16.6 pmol/l, respectively) (P<0.0001). Conclusion In patients admitted with sepsis or septic shock plasma proADM is strongly associated with the severity of disease, vasopressor requirement, and short-term mortality. Our prediction model for mortality, based on the best 4 predictors, had high sensitivity (94.7%) for nonsurvivors and high specificity (90.9%) for survivors. The best 4 predictors were proADM levels on day 4, C-reactive protein levels on day 4, MV duration, and type of sepsis (patients with severe sepsis or septic shock).