Plasma levels of mid-regional pro-adrenomedullin in sepsis are associated with risk of death.

BACKGROUND: Identifying ICU patients with sepsis and predicting the risk of death are unmet clinical needs.

METHODS: Prospective observational singlecenter study of 120 consecutive ICU patients with suspected severe sepsis at Jerez Hospital. Epidemiological, clinical, laboratory data and MRproADM, Procalcitonin (PCT) and Creactive protein (CRP) levels were recorded at ICU admission and followup.

RESULTS: At ICU discharge, 104 patients were diagnosed with severe sepsis and 39 died. Plasma MRproADM was highly indicative of sepsis: 4.05 nmol/l vs of 0.309 nmol/l (p < 0.001), with area under the ROC curve (AUCROC) was 0.947. At 48 hours following admission, the median MRproADM levels in surviving sepsis patients fell to 1.65 nmol/l but remained higher in the nonsurvivors (2.475 nmol/l) (p = 0.04). On day 5 the levels fell to 1.36 nmol/l in surviving sepsis patients vs 3.42 nmol/l in the non survivors (p<0.001). On day 5 the survivors showed greater MRproADM clearance (62.7% vs 21.2%). The AUCROC on day 5 was 0.825, PCT 0.725 and CRP 0.700. The AUCROC to MRproADM clearance on day 5 was 0.734. In a multivariable model, MRproADM levels at 48 hours and on day 5 and clearance on day 5 following admission were statistically significant predictive factors of mortality.

CONCLUSIONS: In clinical practice, in ICU patients admitted with SIRS and organ dysfunction, an MRproADM cutoff point of 1.425 nmol/l helps to identify those with sepsis. An MRproADM value above 5.626 nmol/l 48 hours after admission was associated with a high risk of death.