Postoperative Pro-Adrenomedullin Levels Predict Mortality in Thoracic Surgery Patients. Issue 2 (February 2015)

• Record Type: Journal Article
• Authors: Schoe, Abraham; Schippers, Emile F.; Struck, Joachim; Ebmeyer, Stefan; Klautz, Robert J.M.; de Jonge, Evert; van Dissel, Jaap T.
• Is Part Of: Critical care medicine. Volume 43:Issue 2(2015)
• Publication Date: 2015-02
• Subjects: Critical care medicine -- Periodicals; Soins intensifs -- Périodiques; 616.028
• DOI: 10.1097/CCM.0000000000000709
• Languages: English
• ISSNs: 0090-3493

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Objectives:</title> <p>Risk assessment in ICU patients using commonly used prognostic models may be influenced using different data definitions and by errors in data collection. We investigated whether a set of biomarkers (procalcitonin, MR-pro-adrenomedullin, CT-pro-endothelin-1, CT-pro-arginine vasopressin, and MR-pro-atrial natriuretic peptide), alone or as a panel, could be useful in postoperative risk assessment for hospital mortality in comparison with the Acute Physiology and Chronic Health Evaluation IV score.</p> </sec> <sec> <title>Design:</title> <p>In a prospective observational cohort study, we analyzed 800 consecutive patients undergoing elective cardiac surgery. We assessed biomarker levels on admission to the ICU and every 6 hours thereafter for 24 hours. For every postoperative time point and for every biomarker, we determined the predictive value for hospital mortality and made a comparison with the Acute Physiology and Chronic Health Evaluation IV score.</p> </sec> <sec> <title>Setting:</title> <p>Intensive care of an academic referral hospital.</p> </sec> <sec> <title>Patients:</title> <p>A total of 800 consecutive patients undergoing elective cardiac surgery.</p> </sec> <sec> <title>Interventions:</title> <p>None.</p> </sec> <sec> <title>Measurements and Main Results:</title> <p>MR-pro-adrenomedullin is a good predictor of mortality (<italic>c</italic>-statistic at time point 6 hr after admission to the ICU, 0.940; 95% CI, 0.918–0.956) and performed better than the Acute Physiology and Chronic Health Evaluation IV score (<italic>c</italic>-statistic, 0.842; 95% CI, 0.811–0.868). The <italic>c</italic>-statistic did not change significantly on the time points 6, 12, and 18 hours after admission. Using a cutoff value for proadrenomedullin taken 6 hours after admission on ICU (time point 2) of 3.2 nmol/L sensitivity was 81.8% and specificity 93.9%, the positive likelihood ratio was 13.3, positive predictive value was 31.0%, and negative predictive value was 99.4%. Patients with a MR-pro-adrenomedullin above this cutoff level had an odds ratio of 68.9 (95% CI, 22.2–213.1) for not surviving their hospital stay. The other biomarkers had less predictive power.</p> </sec> <sec> <title>Conclusions:</title> <p>In elective cardiac surgery, MR-pro-adrenomedullin measured between 6 and 18 hours after admission to the ICU is a better predictor of hospital mortality in comparison with the Acute Physiology and Chronic Health Evaluation IV score.</p> </sec> </abstract>