Initial levels of mr-proadrenomedullin: a predictor of severity in patients with influenza a virus pneumonia

Introduction High levels of MR-proadrenomedullin (MR-proADM) have been described in critical sepsis patients. This is directly related to the relaxation of vascular tone and, therefore, hypotension and the presence of organ failure in patients with septic shock. In patients with severe pneumonia due to influenza A, although without great hemodynamic compromise, the presence of respiratory failure worsens the prognosis and significantly increases mortality.


Introduction
High levels of MR-proadrenomedullin (MR-proADM) have been described in critical sepsis patients. This is directly related to the relaxation of vascular tone and, therefore, hypotension and the presence of organ failure in patients with septic shock. In patients with severe pneumonia due to influenza A, although without great hemodynamic compromise, the presence of respiratory failure worsens the prognosis and significantly increases mortality.

Objective
Evaluate the usefulness of MR-proADM comparing them to C-reactive protein (CRP) and procalcitonin (PCT) in the prognosis of patients with influenza A virus pneumonia.

Methods
Prospective observational multicenter study. We included patients admitted to the ICU of five hospitals in Spain with the diagnosis of severe sepsis during a period of 36 months due to influenza A virus pneumonia. Biomarker levels (MR-proADM, CRP, PCT) were determined at admission. Data were compared with a control group (CG) of patients, also with influenza virus A pneumonia, but less severe who were not admitted to the ICU.
The area under the ROC curve (AUC) for prognostic severity (ICU admission) was 0.6769 (p < 0.0961) for CRP levels, 0.5767 (p < 0.543) for PCT levels and 0.87058 for MR-proADM levels (p < 0.0001). The optimal cutoff for severity (ICU admission) MR_proADM levels at admission was 1.09 nmol / l, with a sensitivity of 73.53% and a specificity of 96%. (Figure 2).
In the multivariate analysis (Cox proportional hazards models) only MR-proADM levels at admission, were statistically significant predictive factors for mortality in the ICU and at 90 days. (Table 1) Conclusions Initial MR-proADM levels are effective to determine the unfavorable outcome and the risk of ICU admission and mortality in patients with pneumonia due to influenza A virus.
Authors' details 1 Hospital del SAS de Jerez, Critical Care Medicine, Jerez de la Frontera, Spain.

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