MR-proADM and MR-proANP levels in patients with acute pulmonary embolism.

Önsel Öner,Mehmet Balin,Figen Deveci,Mutlu Kuluöztürk,Selda Telo

doi:10.2478/jomb-2019-0049

Abstract

The aim of this study was to determine levels of Mid-regional Pro-adrenomedullin (MR-proADM) and Mid-regional Pro-atrial Natriuretic Peptide (MR-proANP) in patients with acute pulmonary embolism (PE), the relationship between these parameters and the risk classification in addition to determining the relationship between 1and 3month mortality. 82 PE patients and 50 healthy control subjects were included in the study. Blood samples for Mr-proANP and Mr-proADM were obtained from the subjects prior to the treatment. Risk stratification was determined according to sPESI (Simplified Pulmonary Embolism Severity Index). Following these initial measurements, cases with PE were assessed in terms of all causative and PE related mortalities. The mean serum Mr-proANP and Mr-proADM levels in acute PE patients were found to be statistically higher compared to the control group (p < 0.001, p < 0.01; respectively) and statistically significantly higher in high-risk patients than low-risk patients (p < 0.01, p < 0.05; respectively). No statistical difference was determined in high-risk patients in case of sPESI compared to low-risk patients while hospital mortality rates were higher. It was determined that the hospital mortality rate in cases with Mr-proANP ≥ 123.30 pmol/L and the total 3-month mortality rate in cases with Mr-proADM ≥ 152.2 pg/mL showed a statistically significant increase. This study showed that Mr-proANP and MRproADM may be an important biochemical marker for determining high-risk cases and predicting the mortality in PE patients and we believe that these results should be supported by further and extensive studies.

Highlights

Classification of the Pulmonary embolism (PE) patients for early mortality as a high-risk, intermediate-risk or low-risk determines the treatment options and prognosis [1]
This study showed that MR-proANP and MRproADM may be an important biochemical marker for determining high-risk cases and predicting the mortality in PE patients and we believe that these results should be supported by further and extensive studies
There was no significant difference in gender (p > 0.05, X2 = 0.096) between high- and low-risk simplified PESI score (sPESI) groups while the mean age of the high-risk cases was statistically higher than the low-risk cases (p < 0.01)

Summary

Introduction

Classification of the Pulmonary embolism (PE) patients for early mortality as a high-risk, intermediate-risk or low-risk determines the treatment options and prognosis [1]. Clinical parameters [Pulmonary Embolism Severity Index (PESI), simplified PESI score (sPESI)], right ventricular dysfunction (RVD) markers, thrombotic load markers and myocardial damage markers in hemodynamically stable acute symptomatic PE cases are the most commonly used prognostic factors. In the determination of the risk of early poor prognosis in normotensive PE cases, none of the findings, such as high risk in clinical scoring, presence of RVD or increased levels of cardiac markers, are sufficient by itself. Adrenomedullin (ADM) is a vasodilating peptide released from endothelial tissue in organs such as lungs, heart and gastrointestinal tract. Midregional pro-ADM (MR-proADM), a more stable peptide, was found to be an important prognostic marker [3]. MR-proANP and MR-proADM were reported to have a significant diagnostic and prognostic value in a series of cases with acute dyspnea [4]

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