Skip to main content

Advertisement

Volume 3 Supplement 1

ESICM LIVES 2015

Sustained prognostic value of proadrenomedulin in severe sepsis and septic shock

Article metrics

  • 283 Accesses

Introduction

In sepsis, none of the prognostic biomarkers employed have shown the necessary sensitivity and specificity to be used routinely in clinical practice. In this research we analyze the relationship between proADM an other routinely biomarkers employed in the management of severe sepsis with mortality.

Methods

Prospective observational study. Plasmatic levels of ProADM, C reactive protein (CRP) and procalcitonin (PCT) and lactate in 110 consecutive patients admitted to ICU with severe sepsis / septic shock at days 1st, 3rd and 7th after admission. Clinical and demographic data: age, gender, comorbidities, APACHE II and SOFA scores. Recruited period over 12 months. Statistical analysis: χ2 test for categorical variables. AUROC for diagnostic prediction of mortality. Spearman Karber test for correlations between severity scores and biomarker levels. Multivariate Cox regression analysis adjusted by age, gender and APACHE II score to assess the impact of variables on mortality across the time. Statistical significance: p < 0.05.

Results

110 patients. Male: 63%; APACHE II score: 21; SOFA score: 8.5; Septic shock: 86%; ICU mortality: 32.7%; Respiratory focus: 49%; Gram negatives: 33%; Gram positives 30%.

ProADM was the biomarker showing better prognostic accuracy in any time points analyzed by AUROC (p) for 28 day mortality, better than SOFA score at 1st and 7th days of admission: At day 1st proADM = 0.80 (p < 0.001); PCT = 0.62 (p = n.s); lactate = 0.71 (p < 0.001); CRP = 0.47 (p = n.s); SOFA 0.77 (p < 0.001); APACHE II = 0.72 (p < 0.001). At day 3rd proADM = 0.85 (p < 0.001); PCT = 0.68 (p = 0.025); lactate = 0.78 (p < 0.001); CRP = 0.49 (p =n.s); SOFA = 0.86 (p < 0.001). At day 7th ProADM = 0.83 (p < 0.001); PCT = 0.67 (p = n.s); lactate = 0.62 (p = n.s); CRP = 0.61 (p=n.s); SOFA = 0.81 (p = 0.03).

Correlation test showed that proADM present the strongest association with SOFA in all time points analyzed [r; (p)]. At day 1st proADM = 0.71 ( < 0.001); PCT = 0.43 (p < 0.001); lactate = 0.50 (p < 0.001); CRP = 0.52 (p=n.s). At day 3rd proADM = 0.69 (p < 0.001); PCT = 0.51 (p>0.001); lactate = 0.51 (p < 0.001); PCR = 0.23 (p = n.s). At day 7th proADM = 0.63 (p < 0.001); PCT = 0.14 (p=n.s); lactate = 0.40 (p= 0.02); CRP = 0.47 (p=n.s).

Multivariate Cox regression analysis showed proADM as the only biomarker showing association with mortality at day 28th in all time points analyzed [HR; p value; (CI)]. ProADM day 1st: [HR=1.085; p = 0.03; CI (1.05-1.170)]; proADM day 3rd [HR=1.051; p = 0.03; CI (1.001-1.104)]; proADM day 7th [HR=1.234; p= 0.001; CI (1.096-1.389)].

Conclusions

ProADM is a consistent marker of mortality risk and severity along time in severe sepsis and septic shock. This provides a selective advantage over other biomarkers as prognostic tool. The inclusion in clinical practice could help to intensivist, along with the rest of biomarkers and scores of severity, for better optimization in making decisions for management and establish prognosis of this disease.

Author information

Correspondence to R Cicuendez.

Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0), which permits use, duplication, adaptation, distribution, and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Cicuendez, R., Nogales, L., Bueno, A. et al. Sustained prognostic value of proadrenomedulin in severe sepsis and septic shock. ICMx 3, A792 (2015) doi:10.1186/2197-425X-3-S1-A792

Download citation

Keywords

  • Lactate
  • Septic Shock
  • Severe Sepsis
  • Prospective Observational Study
  • Selective Advantage