Ann Lab Med.  2019 Sep;39(5):454-463. 10.3343/alm.2019.39.5.454.

Circulating Biologically Active Adrenomedullin Predicts Organ Failure and Mortality in Sepsis

• Kim H
• Hur M
• Struck J
• Bergmann A
• Di Somma S

• KMID: 2450968
• DOI: http://doi.org/10.3343/alm.2019.39.5.454

Abstract

BACKGROUND
Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Biologically active adrenomedullin (bio-ADM) is an emerging biomarker for sepsis. We explored whether bio-ADM concentration could predict severity, organ failure, and 30-day mortality in septic patients.
METHODS
In 215 septic patients (109 patients with sepsis; 106 patients with septic shock), bio-ADM concentration was measured at diagnosis of sepsis, using sphingotest bio-ADM (Sphingotec GmbH, Hennigsdorf, Germany) and analyzed in terms of sepsis severity, vasopressor use, and 30-day mortality. The number of organ failures, sequential (sepsis-related) organ failure assessment (SOFA) score, and 30-day mortality were compared according to bio-ADM quartiles.
RESULTS
Bio-ADM concentration was significantly higher in patients with septic shock, vasopressor use, and non-survivors than in patients with solitary sepsis, no vasopressor use, and survivors, respectively (all P<0.0001). Bio-ADM quartiles were associated with the number of organ failures (P<0.0001), as well as SOFA cardiovascular, renal, coagulation, and liver subscores (all P<0.05). The 30-day mortality rate showed a stepwise increase in each bio-ADM quartile (all P<0.0001). Bio-ADM concentration and SOFA score equally predicted the 30-day mortality (area under the curve: 0.827 vs 0.830).
CONCLUSIONS
Bio-ADM could serve as a useful and objective biomarker to predict severity, organ failure, and 30-day mortality in septic patients.

Keyword

Bio-ADM; Sepsis; Organ failure; Mortality

MeSH Terms

Adrenomedullin*
Diagnosis
Humans
Liver
Mortality*
Sepsis*
Shock, Septic
Survivors
Adrenomedullin

Figure

• 

  Fig. 1 Comparison of bio-adrenomedullin (bio-ADM) concentrations according to sepsis severity (A), vasopressor use (B), and survival (C). In each figure, the Y axis is presented as a logarithmic scale, and the red line indicates the medical decision point (70 pg/mL) of bio-ADM.

• 

  Fig. 2 Number of organ failures (A) and distribution of sequential (sepsis-related) organ failure assessment (SOFA) cardiovascular subscore (B) according to bio-adrenomedullin (bio-ADM) quartiles.

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  Fig. 3 Prediction of 30-day mortality in sepsis using bio-ADM quartiles (A–C) and medical decision point (70 pg/mL) (D–F).Abbreviations: bio-ADM, bio-adrenomedullin; HR, hazard ratio.

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  Fig. 4 Prediction of 30-day mortality in sepsis using sequential (sepsis-related) organ failure assessment (SOFA) cardiovascular subscores (A) and lactate quartiles (B).

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