2024-03-29T06:30:43Zhttps://uvadoc.uva.es/oai/requestoai:uvadoc.uva.es:10324/449312021-06-24T07:25:48Zcom_10324_41462com_10324_954com_10324_894col_10324_41463
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, Cristina
Nogales, Leonor
Eiros Bouza, José María
Tamayo Gómez, Eduardo
Gandía Martínez, Francisco
Bermejo Martín, Jesús Francisco
Charles, Pierre Emmanuel
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
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