Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

Plasma bioactive adrenomedullin on intensive care unit admission is associated with acute respiratory distress syndrome : an observational study

Johnsson, Patrik LU ; Fredriksson, Andrea ; Tung, Christer ; Friberg, Hans LU and Frigyesi, Attila LU (2023) In Intensive Care Medicine Experimental 11. p.1-15
Abstract

Background: Bioactive adrenomedullin (bio-ADM) is a vasoactive peptide with a key role in reducing vascular hyperpermeability and improving endothelial stability during infection, but it also has vasodilatory properties. Bioactive ADM has not been studied in conjunction with acute respiratory distress syndrome (ARDS), but it has recently been shown to correlate with outcomes after severe COVID-19. Therefore, this study investigated the association between circulating bio-ADM on intensive care unit (ICU) admission and ARDS. The secondary aim was the association between bio-ADM and ARDS mortality. Methods: We analysed bio-ADM levels and assessed the presence of ARDS in adult patients admitted to two general intensive care units in... (More)

Background: Bioactive adrenomedullin (bio-ADM) is a vasoactive peptide with a key role in reducing vascular hyperpermeability and improving endothelial stability during infection, but it also has vasodilatory properties. Bioactive ADM has not been studied in conjunction with acute respiratory distress syndrome (ARDS), but it has recently been shown to correlate with outcomes after severe COVID-19. Therefore, this study investigated the association between circulating bio-ADM on intensive care unit (ICU) admission and ARDS. The secondary aim was the association between bio-ADM and ARDS mortality. Methods: We analysed bio-ADM levels and assessed the presence of ARDS in adult patients admitted to two general intensive care units in southern Sweden. Medical records were manually screened for the ARDS Berlin criteria. The association between bio-ADM levels and ARDS and mortality in ARDS patients was analysed using logistic regression and receiver-operating characteristics analysis. The primary outcome was an ARDS diagnosis within 72 h of ICU admission, and the secondary outcome was 30-day mortality. Results: Out of 1224 admissions, 11% (n = 132) developed ARDS within 72 h. We found that elevated admission bio-ADM level was associated with ARDS independently of sepsis status and of organ dysfunction as measured by the Sequential organ failure assessment (SOFA) score. Both lower levels (< 38 pg/L) and high (> 90 pg/L) levels of bio-ADM were independently (of the Simplified acute physiology score, SAPS-3) predictive of mortality. Patients with indirect mechanisms of lung injury had higher bio-ADM levels than those with a direct mechanism of injury, and bio-ADM increased with increasing ARDS severity. Conclusions: High levels of bio-ADM on admission are associated with ARDS, and bio-ADM levels significantly differ depending on the injury mechanism. In contrast, both high and low levels of bio-ADM are associated with mortality, possibly due to the dual action of bio-ADM in stabilising the endothelial barrier and causing vasodilation. These findings could lead to improved diagnostic accuracy of ARDS and potentially lead to new therapeutic strategies.

(Less)
Please use this url to cite or link to this publication:
author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Adrenomedullin, Adult respiratory distress syndrome, Biomarker, COVID-19, Endothelial function, Sepsis
in
Intensive Care Medicine Experimental
volume
11
article number
10
pages
1 - 15
publisher
Springer
external identifiers
  • scopus:85149529028
  • pmid:36864354
ISSN
2197-425X
DOI
10.1186/s40635-023-00494-7
project
Acute Respiratory Distress Syndrome i Skåne
language
English
LU publication?
yes
additional info
Funding Information: We would like to thank all staff at the ICUs of Skåne University Hospital in Malmö and Lund for contributing to this study. In addition, this study would not have been possible without the kind contribution of SphingoTec GmbH, who analysed our blood samples free of charge. Funding Information: Open access funding provided by Lund University. AF was supported by research grants from the Governmental funding of clinical research within the Swedish National health service 2019:YF0053, the Crafoord Foundation 2022, and the Lions Foundation. HF was supported by research grants from the Governmental funding of clinical research within the Swedish National health service, the Swedish Heart and Lung foundation and the Trolle-Wachteister foundation. Publisher Copyright: © 2023, The Author(s).
id
fd857727-40ec-4375-b5f2-fe3b5e77af46
date added to LUP
2023-04-20 19:27:15
date last changed
2024-06-16 04:38:12
@article{fd857727-40ec-4375-b5f2-fe3b5e77af46,
  abstract     = {{<p>Background: Bioactive adrenomedullin (bio-ADM) is a vasoactive peptide with a key role in reducing vascular hyperpermeability and improving endothelial stability during infection, but it also has vasodilatory properties. Bioactive ADM has not been studied in conjunction with acute respiratory distress syndrome (ARDS), but it has recently been shown to correlate with outcomes after severe COVID-19. Therefore, this study investigated the association between circulating bio-ADM on intensive care unit (ICU) admission and ARDS. The secondary aim was the association between bio-ADM and ARDS mortality. Methods: We analysed bio-ADM levels and assessed the presence of ARDS in adult patients admitted to two general intensive care units in southern Sweden. Medical records were manually screened for the ARDS Berlin criteria. The association between bio-ADM levels and ARDS and mortality in ARDS patients was analysed using logistic regression and receiver-operating characteristics analysis. The primary outcome was an ARDS diagnosis within 72 h of ICU admission, and the secondary outcome was 30-day mortality. Results: Out of 1224 admissions, 11% (n = 132) developed ARDS within 72 h. We found that elevated admission bio-ADM level was associated with ARDS independently of sepsis status and of organ dysfunction as measured by the Sequential organ failure assessment (SOFA) score. Both lower levels (&lt; 38 pg/L) and high (&gt; 90 pg/L) levels of bio-ADM were independently (of the Simplified acute physiology score, SAPS-3) predictive of mortality. Patients with indirect mechanisms of lung injury had higher bio-ADM levels than those with a direct mechanism of injury, and bio-ADM increased with increasing ARDS severity. Conclusions: High levels of bio-ADM on admission are associated with ARDS, and bio-ADM levels significantly differ depending on the injury mechanism. In contrast, both high and low levels of bio-ADM are associated with mortality, possibly due to the dual action of bio-ADM in stabilising the endothelial barrier and causing vasodilation. These findings could lead to improved diagnostic accuracy of ARDS and potentially lead to new therapeutic strategies.</p>}},
  author       = {{Johnsson, Patrik and Fredriksson, Andrea and Tung, Christer and Friberg, Hans and Frigyesi, Attila}},
  issn         = {{2197-425X}},
  keywords     = {{Adrenomedullin; Adult respiratory distress syndrome; Biomarker; COVID-19; Endothelial function; Sepsis}},
  language     = {{eng}},
  pages        = {{1--15}},
  publisher    = {{Springer}},
  series       = {{Intensive Care Medicine Experimental}},
  title        = {{Plasma bioactive adrenomedullin on intensive care unit admission is associated with acute respiratory distress syndrome : an observational study}},
  url          = {{http://dx.doi.org/10.1186/s40635-023-00494-7}},
  doi          = {{10.1186/s40635-023-00494-7}},
  volume       = {{11}},
  year         = {{2023}},
}