Plasma Adrenomedullin in Critically Ill Patients with Sepsis after Major Surgery - A pilot study

• Published in: Journal of critical care 2017-04, Vol.38, p.68-72
• Main Authors: Simon, Tim-Philipp, Martin, Lukas, Doemming, Sabine, Humbs, Andreas, Bruells, Christian, Kopp, Ruedger, Hartmann, Oliver, Struck, Joachim, Bergmann, Andreas, Marx, Gernot, Schuerholz, Tobias
• Format: Article
• Language: English
• Subjects: Adrenomedullin; Adrenomedullin - blood; Adult; Aged; Biomarker; Biomarkers - blood; Case-Control Studies; Critical Care; Emergency Service, Hospital; Female; Hospitals; Humans; Hypoxia; Immunoassay; Intensive care; Intensive Care Units; Laboratories; Length of Stay; Male; Middle Aged; Morbidity; Mortality; Patients; Peptides; Pilot Projects; Plasma; Postoperative Complications - blood; Postoperative Complications - diagnosis; Postoperative Complications - mortality; Predictive Value of Tests; Prospective Studies; Sepsis; Shock, Septic - blood; Shock, Septic - diagnosis; Shock, Septic - mortality; Studies; Surgery; Surgical; Thoracic surgery
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2016.10.017

Abstract Purpose Adrenomedullin is released by different tissues in hypoxia, oxidative stress, and inflammation and is found in general and medical patients, and recently in sepsis patients in emergency departments. Aim of this study was to evaluate biologically active adrenomedullin that mirrors directly the active peptide levels in plasma of surgical ICU-patients with sepsis. Materials and Methods In this single-center observational pilot trial, 42 ICU patients with sepsis and 14 patients after major surgery were included after sepsis diagnosis or ICU admission. Results Patients (66% male) were 70 (median; (Interquartile range (IQR) 61–77)) years and had a body mass index of 26.2 (24.2–29.4) kg/m2 . The ICU and hospital length of stay was 8 (1–22) and 17 (8–21) days, respectively. Eight patients had sepsis, 19 developed severe sepsis, and 15 suffered from septic shock. Adrenomedullin increased with severity (sepsis: 25.8 pg/ml (IQR 20.3–40.2), severe sepsis 84.2 pg/ml (IQR 42.7–118.5), septic shock (119.7 pg/ml; IQR 83.8–172.6); P < .0001). Higher adrenomedullin was associated with poor 90-day outcomes (P = .019) and more frequent vasopressor use (P = .001). Conclusions This is the first study investigating adrenomedullin in patients with sepsis following major surgery. Higher adrenomedullin on admission is associated with increased vasopressor need and mortality after 90 days. Thus, adrenomedullin may be a useful additional parameter in surgical patients with sepsis.