Mid-regional pro-adrenomedullin (MR-proADM), a marker of positive fluid balance in critically ill patients: results of the ENVOL study. Issue 1 (December 2016)

• Record Type: Journal Article
• Authors: Vigué, Bernard; Leblanc, Pierre-Etienne; Moati, Frédérique; Pussard, Eric; Foufa, Hussam; Rodrigues, Aurore; Figueiredo, Samy; Harrois, Anatole; Mazoit, Jean-Xavier; Rafi, Homa; Duranteau, Jacques
• Is Part Of: Critical care. Volume 20:Issue 1(2016)
• Page Start: 1
• Page End: 9
• Publication Date: 2016-12
• Subjects: MR-proADM -- Adrenomedullin -- Intensive care unit -- Plasma biomarker -- Fluid balance -- Fluid overload -- Sodium overload; Critical care medicine -- Periodicals; 616.02805
• DOI: 10.1186/s13054-016-1540-x
• Languages: English
• ISSNs: 1364-8535

Abstract

Abstract Background The optimal control of blood volume without fluid overload is a main challenge in the daily care of intensive care unit (ICU) patients. Accordingly this study focused on the identification of biomarkers to help characterize fluid overload status. Methods Sixty-seven patients were studied from ICU admission to day 7 (D7 ). Blood and urine samples were taken daily and sodium and water balance strictly calculated resulting in a total cumulative assessment of ∆Na+ and ∆H2 O. Furthermore, plasmatic biomarkers (cortisol, epinephrine, norepinephrine, renin, angiotensin II, aldosterone, pro-endothelin, copeptine, atrial natriuretic peptide, erythropoietin, mid-regional pro-adrenomedullin (MR-proADM)) and Sequential Organ Failure Assessment (SOFA) scores were measured at D2, D5 and D7 . Blood volumes were measured with51 Cr fixed on red blood cells at D2 and D7 . Results The ∆Na+ or ∆H2 O were increased in all patients but never related to blood volumes at D2 nor D7 . Total blood volumes were at normal values with constantly low red blood cell volumes and normal or decreased plasmatic volume. Weight, plasmatic proteins, and hemoglobin were weakly related to ∆Na+ or ∆H2 O. Amongst all tested biomarkers, only MR-proADM was related to sodium and fluid overload. This biomarker was also a predictor of SOFA scores. Conclusions Plasmatic concentration in MR-proADM seems to be a good surrogate for evaluation of ∆Na+ or ∆H2 O and predicts sodium and extracellular fluid overload. Trial registration ClinicalTrials.gov:NCT01858675 in May 13, 2013.