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2021-01-12T10:43:48Z urn:hdl:10324/44931 Superior accuracy of mid-regional proadrenomedullin for mortality prediction in sepsis with varying levels of illness severity Andaluz Ojeda, David Nguyen, H. Bryant Meunier-Beillard, Nicolas Cicuéndez, Ramón Quenot, Jean-Pierre Calvo, Dolores Dargent, Auguste Zarca, Esther Andrés Iglesias, Cristina Nogales, Leonor Eiros Bouza, José María Tamayo Gómez, Eduardo Gandía Martínez, Francisco Bermejo Martín, Jesús Francisco Charles, Pierre Emmanuel Producción Científica Background: The use of novel sepsis biomarkers has increased in recent years. However, their prognostic value with respect to illness severity has not been explored. In this work, we examined the ability of mid-regional proadrenomedullin (MR-proADM) in predicting mortality in sepsis patients with different degrees of organ failure, compared to that of procalcitonin, C-reactive protein and lactate. Methods: This was a two-centre prospective observational cohort, enrolling severe sepsis or septic shock patients admitted to the ICU. Plasma biomarkers were measured during the first 12 h of admission. The association between biomarkers and 28-day mortality was assessed by Cox regression analysis and Kaplan–Meier curves. Patients were divided into three groups as evaluated by the Sequential Organ Failure Assessment (SOFA) score. The accuracy of the biomarkers for mortality was determined by area under the receiver operating characteristic curve (AUROC) analysis. Results: A total of 326 patients with severe sepsis (21.7%) or septic shock (79.3%) were enrolled with a 28-day mortality rate of 31.0%. Only MR-proADM and lactate were associated with mortality in the multivariate analysis: hazard ratio 8.5 versus 3.4 (p < 0.001). MR-proADM showed the best AUROC for mortality prediction at 28 days in the analysis over the entire cohort (AUROC [95% CI] 0.79 [0.74–0.84]) (p < 0.001). When patients were stratified by the degree of organ failure, MR-proADM was the only biomarker to predict mortality in all severity groups (SOFA ≤ 6, SOFA = 7–12, and SOFA ≥ 13), AUROC [95% CI] of 0.75 [0.61–0.88], 0.74 [0.66–0.83] and 0.73 [0.59–0.86], respectively (p < 0.05). All patients with MR-proADM concentrations ≤0.88 nmol/L survived up to 28 days. In patients with SOFA ≤ 6, the addition of MR-proADM to the SOFA score increased the ability of SOFA to identify non-survivors, AUROC [95% CI] 0.70 [0.58–0.82] and 0.77 [0.66–0.88], respectively (p < 0.05 for both). Conclusions: The performance of prognostic biomarkers in sepsis is highly influenced by disease severity. MRproADM accuracy to predict mortality is not affected by the degree of organ failure. Thus, it is a good candidate in the early identification of sepsis patients with moderate disease severity but at risk of mortality. 2021-01-12T10:43:48Z 2021-01-12T10:43:48Z 2017 info:eu-repo/semantics/article Annals of Intensive Care, 2017, vol.7, n. 1 2110-5820 http://uvadoc.uva.es/handle/10324/44931 10.1186/s13613-017-0238-9 1 Annals of Intensive Care 7 2110-5820 eng https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-017-0238-9 info:eu-repo/semantics/openAccess http://creativecommons.org/licenses/by-nc-nd/4.0/ © SpringerOpen Attribution-NonCommercial-NoDerivatives 4.0 Internacional SpringerOpen