Polish archives of internal medicine | 2019
Prognostic value of mid-regional proadrenomedullin in critically ill patients.
Abstract
INTRODUCTION\nMortality risk and outcome in critically ill patients can be predicted by scoring systems. Acute kidney injury (AKI) is also one of the strongest factors negatively influencing patients fate. Mid-regional proadrenomedullin (MR-proADM), shows promising results as outcome predictor in patients with sepsis.\n\n\nOBJECTIVES\nWe aimed to evaluate the value of MR-proADM in incident AKI and mortality prognostication among patients admitted to the intensive care unit (ICU) in comparison to commonly used scoring systems.\n\n\nPATIENTS AND METHODS\nSingle center cohort study performed among 77 patients admitted to ICU. Plasma MR-proADM levels were measured within 24 h of admission. APACHE2 and SOFA scores were used as a reference standard. The primary endpoints were incident AKI and in-hospital mortality.\n\n\nRESULTS\nPatients, who died during hospitalization period, had a higher MR-proADM concentration (2592.5 pg/ml vs 995.3 pg/ml, p<0.001). Levels of MR-proADM positively correlated with APACHE2 or SOFA score (r=0.3 p=0.004 and r=0.3 p=0.008, respectively). In ROC analysis MR-proADM concentration was superior to both scoring systems (p=0.002 and p=0.001, respectively). In univariate logistic regression MR-proADM was associated with in-hospital mortality (OR 1.22 95%CI 1.11-1.35 per 100 pg/ml increase of MR-proADM) and after adjusting for multiple variables remained an independent predictor of death (1.35 95%CI 1.22-1.49 per 100 pg/ml increase of MR-proADM). MR-proADM was not useful in prediction of incident AKI.\n\n\nCONCLUSIONS\nMR-proADM can be applied in clinical practice as a prognostic tool of mortality but not incident AKI in the general ICU population with at least similar accuracy as APACHE2 and SOFA.