Original article
Mid-regional proadrenomedullin: An early marker of response in critically ill patients with severe community-acquired pneumonia?
J.M. Pereiraa,b,, , A. Azevedoc,d,e, C. Basílioa, C. Sousa-Diasa, P. Mergulhãoa,b, J.A. Paivaa,b
a Emergency and Intensive Care Department, Centro Hospitalar São João EPE, Porto, Portugal
b Department of Medicine, University of Porto Medical School, Porto, Portugal
c Hospital Epidemiology Centre, Centro Hospitalar São João EPE, Porto, Portugal
d Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Portugal
e EPIUnit – Institute of Public Health, University of Porto, Portugal
Received 07 February 2016, Accepted 09 March 2016
Abstract
Background

Mid-regional proadrenomedullin (MR-proADM) is a novel biomarker with potential prognostic utility in patients with community-acquired pneumonia (CAP).

Purpose

To evaluate the value of MR-proADM levels at ICU admission for further severity stratification and outcome prediction, and its kinetics as an early predictor of response in severe CAP (SCAP).

Materials and methods

Prospective, single-center, cohort study of 19 SCAP patients admitted to the ICU within 12h after the first antibiotic dose.

Results

At ICU admission median MR-proADM was 3.58nmol/l (IQR: 2.83–10.00). No significant association was found between its serum levels at admission and severity assessed by SAPS II (Spearman's correlation=0.24, p=0.31) or SOFA score (SOFA<10: <3.45nmol/l vs. SOFA10: 3.90nmol/l, p=0.74). Hospital and one-year mortality were 26% and 32%, respectively. No significant difference in median MR-proADM serum levels was found between survivors and non-survivors and its accuracy to predict hospital mortality was bad (aROC 0.53). After 48h of antibiotic therapy, MR-proADM decreased in all but 5 patients (median −20%; IQR −56% to +0.1%). Its kinetics measured by the percent change from baseline was a good predictor of clinical response (aROC 0.80). The best discrimination was achieved by classifying patients according to whether MR-proADM decreased or not within 48h. No decrease in MR-proADM serum levels significantly increased the chances of dying independently of general severity (SAPS II-adjusted OR 174; 95% CI 2–15,422; p=0.024).

Conclusions

In SCAP patients, a decrease in MR-proADM serum levels in the first 48h after ICU admission was a good predictor of clinical response and better outcome.

Keywords
Proadrenomedullin, Biomarkers, Severe community acquired pneumonia, Outcome, Critically ill patients
Abbreviations
CAP, ICU, COPD, SAPS, PIRO, SOFA, PSI, MR-proADM, SD, IQR, ROC, aROC

Metrics

  • Impact Factor: 1.560(2016)
  • 5-years Impact Factor: 1,100
  • SCImago Journal Rank (SJR):0,29
  • Source Normalized Impact per Paper (SNIP):0,685