Circulating bioactive adrenomedullin as a marker of sepsis, septic shock and critical illness
Lundberg, Oscar H.M. LU
; Lengquist, Maria
LU
; Spångfors, Martin
LU
; Annborn, Martin
LU
; Bergmann, Deborah
; Schulte, Janin
; Levin, Helena
LU
; Melander, Olle
LU
; Frigyesi, Attila
LU
and Friberg, Hans
LU
(2020)
In Critical Care
24(1).
- Abstract
Background: Biomarkers can be of help to understand critical illness and to identify and stratify sepsis. Adrenomedullin is a vasoactive hormone, with reported prognostic and potentially therapeutic value in sepsis. The primary aim of this study was to investigate the association of circulating bioactive adrenomedullin (bio-ADM) levels at intensive care unit (ICU) admission with mortality in sepsis patients and in a general ICU population. Secondary aims included the association of bio-ADM with organ failure and the ability of bio-ADM to identify sepsis. Methods: In this retrospective observational study, adult patients admitted to one of four ICUs during 2016 had admission bio-ADM levels analysed. Age-adjusted odds ratios (OR) with 95%... (More)
Background: Biomarkers can be of help to understand critical illness and to identify and stratify sepsis. Adrenomedullin is a vasoactive hormone, with reported prognostic and potentially therapeutic value in sepsis. The primary aim of this study was to investigate the association of circulating bioactive adrenomedullin (bio-ADM) levels at intensive care unit (ICU) admission with mortality in sepsis patients and in a general ICU population. Secondary aims included the association of bio-ADM with organ failure and the ability of bio-ADM to identify sepsis. Methods: In this retrospective observational study, adult patients admitted to one of four ICUs during 2016 had admission bio-ADM levels analysed. Age-adjusted odds ratios (OR) with 95% CI for log-2 transformed bio-ADM, and Youden’s index derived cut-offs were calculated. The primary outcome was 30-day mortality, and secondary outcomes included the need for organ support and the ability to identify sepsis. Results: Bio-ADM in 1867 consecutive patients were analysed; 632 patients fulfilled the sepsis-3 criteria of whom 267 had septic shock. The median bio-ADM in the entire ICU population was 40 pg/mL, 74 pg/mL in sepsis patients, 107 pg/mL in septic shock and 29 pg/mL in non-septic patients. The association of elevated bio-ADM and mortality in sepsis patients and the ICU population resulted in ORs of 1.23 (95% CI 1.07–1.41) and 1.22 (95% CI 1.12–1.32), respectively. The association with mortality remained after additional adjustment for lactate in sepsis patients. Elevated bio-ADM was associated with an increased need for dialysis with ORs of 2.28 (95% CI 2.01–2.59) and 1.97 (95% CI 1.64–2.36) for the ICU population and sepsis patients, respectively, and with increased need of vasopressors, OR 1.33 (95% CI 1.23–1.42) (95% CI 1.17–1.50) for both populations. Sepsis was identified with an OR of 1.78 (95% CI 1.64–1.94) for bio-ADM, after additional adjustment for severity of disease. A bio-ADM cut-off of 70 pg/mL differentiated between survivors and non-survivors in sepsis, but a Youden’s index derived threshold of 108 pg/mL performed better. Conclusions: Admission bio-ADM is associated with 30-day mortality and organ failure in sepsis patients as well as in a general ICU population. Bio-ADM may be a morbidity-independent sepsis biomarker.
(Less)
- author
- Lundberg, Oscar H.M.
LU
; Lengquist, Maria
LU
; Spångfors, Martin
LU
; Annborn, Martin
LU
; Bergmann, Deborah
; Schulte, Janin
; Levin, Helena
LU
; Melander, Olle
LU
; Frigyesi, Attila
LU
and Friberg, Hans
LU
- organization
- publishing date
- 2020
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Adrenomedullin, Bioactive adrenomedullin, Biomarkers, Critical illness, Cut-off, Sepsis, Septic shock
- in
- Critical Care
- volume
- 24
- issue
- 1
- article number
- 636
- publisher
- BioMed Central (BMC)
- external identifiers
-
- pmid:33148300
- scopus:85094960622
- ISSN
- 1364-8535
- DOI
- 10.1186/s13054-020-03351-1
- project
- SweCrit, a critical care biobank
- Identification and classification of sepsis in the intensive care unit
- language
- English
- LU publication?
- yes
- id
- f602e7ad-a9b7-4380-af31-8343b70b3172
- date added to LUP
- 2020-11-13 07:42:44
- date last changed
- 2024-06-14 02:27:57
@article{f602e7ad-a9b7-4380-af31-8343b70b3172,
abstract = {{<p>Background: Biomarkers can be of help to understand critical illness and to identify and stratify sepsis. Adrenomedullin is a vasoactive hormone, with reported prognostic and potentially therapeutic value in sepsis. The primary aim of this study was to investigate the association of circulating bioactive adrenomedullin (bio-ADM) levels at intensive care unit (ICU) admission with mortality in sepsis patients and in a general ICU population. Secondary aims included the association of bio-ADM with organ failure and the ability of bio-ADM to identify sepsis. Methods: In this retrospective observational study, adult patients admitted to one of four ICUs during 2016 had admission bio-ADM levels analysed. Age-adjusted odds ratios (OR) with 95% CI for log-2 transformed bio-ADM, and Youden’s index derived cut-offs were calculated. The primary outcome was 30-day mortality, and secondary outcomes included the need for organ support and the ability to identify sepsis. Results: Bio-ADM in 1867 consecutive patients were analysed; 632 patients fulfilled the sepsis-3 criteria of whom 267 had septic shock. The median bio-ADM in the entire ICU population was 40 pg/mL, 74 pg/mL in sepsis patients, 107 pg/mL in septic shock and 29 pg/mL in non-septic patients. The association of elevated bio-ADM and mortality in sepsis patients and the ICU population resulted in ORs of 1.23 (95% CI 1.07–1.41) and 1.22 (95% CI 1.12–1.32), respectively. The association with mortality remained after additional adjustment for lactate in sepsis patients. Elevated bio-ADM was associated with an increased need for dialysis with ORs of 2.28 (95% CI 2.01–2.59) and 1.97 (95% CI 1.64–2.36) for the ICU population and sepsis patients, respectively, and with increased need of vasopressors, OR 1.33 (95% CI 1.23–1.42) (95% CI 1.17–1.50) for both populations. Sepsis was identified with an OR of 1.78 (95% CI 1.64–1.94) for bio-ADM, after additional adjustment for severity of disease. A bio-ADM cut-off of 70 pg/mL differentiated between survivors and non-survivors in sepsis, but a Youden’s index derived threshold of 108 pg/mL performed better. Conclusions: Admission bio-ADM is associated with 30-day mortality and organ failure in sepsis patients as well as in a general ICU population. Bio-ADM may be a morbidity-independent sepsis biomarker.</p>}},
author = {{Lundberg, Oscar H.M. and Lengquist, Maria and Spångfors, Martin and Annborn, Martin and Bergmann, Deborah and Schulte, Janin and Levin, Helena and Melander, Olle and Frigyesi, Attila and Friberg, Hans}},
issn = {{1364-8535}},
keywords = {{Adrenomedullin; Bioactive adrenomedullin; Biomarkers; Critical illness; Cut-off; Sepsis; Septic shock}},
language = {{eng}},
number = {{1}},
publisher = {{BioMed Central (BMC)}},
series = {{Critical Care}},
title = {{Circulating bioactive adrenomedullin as a marker of sepsis, septic shock and critical illness}},
url = {{http://dx.doi.org/10.1186/s13054-020-03351-1}},
doi = {{10.1186/s13054-020-03351-1}},
volume = {{24}},
year = {{2020}},
}