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Critical Care

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Open Access 01-02-2014 | Research

Plasma adrenomedullin is associated with short-term mortality and vasopressor requirement in patients admitted with sepsis

Authors: Rossella Marino, Joachim Struck, Alan S Maisel, Laura Magrini, Andreas Bergmann, Salvatore Di Somma

Published in: Critical Care | Issue 1/2014

Abstract

Introduction

The incidence of death among patients admitted for severe sepsis or septic shock is high. Adrenomedullin (ADM) plays a central role in initiating the hyperdynamic response during the early stages of sepsis. Pilot studies indicate an association of plasma ADM with the severity of the disease. In the present study we utilized a novel sandwich immunoassay of bioactive plasma ADM in patients hospitalized with sepsis in order to assess the clinical utility.

Methods

We enrolled 101 consecutive patients admitted to the emergency department with suspected sepsis in this study. Sepsis was defined by fulfillment of at least two systemic inflammatory response syndrome (SIRS) criteria plus clinical suspicion of infection. Plasma samples for ADM measurement were obtained on admission and for the next four days. The 28-day mortality rate was recorded.

Results

ADM at admission was associated with severity of disease (correlation with Acute Physiology and Chronic Health Evaluation II (APACHE II) score: r = 0.46; P <0.0001). ADM was also associated with 28-day mortality (ADM median (IQR): survivors: 50 (31 to 77) pg/mL; non-survivors: 84 (48 to 232) pg/mL; P <0.001) and was independent from and additive to APACHE II (P = 0.02). Cox regression analysis revealed an additive value of serial measurement of ADM over baseline assessment for prediction of 28-day mortality (P < 0.01). ADM was negatively correlated with mean arterial pressure (r = -0.39; P <0.0001), and it strongly discriminated those patients requiring vasopressor therapy from the others (ADM median (IQR): no vasopressors 48 (32 to 75) pg/mL; with vasopressors 129 (83 to 264) pg/mL, P <0.0001).

Conclusions

In patients admitted with sepsis, severe sepsis or septic shock plasma ADM is strongly associated with severity of disease, vasopressor requirement and 28-day mortality.

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Title: Plasma adrenomedullin is associated with short-term mortality and vasopressor requirement in patients admitted with sepsis
Authors: Rossella Marino
Joachim Struck
Alan S Maisel
Laura Magrini
Andreas Bergmann
Salvatore Di Somma
Publication date: 01-02-2014
Publisher: BioMed Central
Published in: Critical Care / Issue 1/2014
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/cc13731

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Plasma adrenomedullin is associated with short-term mortality and vasopressor requirement in patients admitted with sepsis

Abstract

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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