Mid-Regional Pro-Adrenomedullin Can Predict Organ Failure and Prognosis in Sepsis?
Abstract
:1. Introduction
2. Results
Baseline Characteristics of Included Population
3. Discussion
3.1. MR-proADM Levels and Organ Damage and Outcome
3.2. Limitations and Perspectives
4. Materials and Methods
4.1. Patient Selection and Study Design
4.2. Ethical Statement
4.3. Clinical Scores, Laboratory Parameters and Blood Gas Analysis
4.4. Definitions and Laboratory Parameters
4.5. MR-proADM Plasma Measurement
4.6. Statistical Analysis
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
References
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Variables | Patients with Sepsis ** N = 301 | Patients with Infection without Sepsis ** N = 126 | ||||
---|---|---|---|---|---|---|
Total | Sepsis * N = 177 | Septic shock * N = 124 | p * | p ** | ||
Age in years, median [IQR] | 74.5 [66.082.0] | 73 [64.0–81.0] | 77 [68.0–83.0] | 0.019 | 79 [69.8–86.0] | 0.0014 |
Sex category, male (%) | 164 (54%) | 97 (54%) | 67 (54%) | 1 | 63 (50%) | 0.45 |
Anamnestic variables, n (%) | ||||||
Cancer | 24 (8%) | 17 (9.6%) | 7 (5.6%) | 0.20 | 27 (21.4%) | 0.0001 |
COPD | 51 (17%) | 31 (17.5%) | 20 (16%) | 0.73 | 38 (30.2%) | 0.002 |
Cardiovascular disease | 113 (37.5%) | 56 (31.6%) | 57 (46%) | 0.0017 | 68 (54%) | 0.011 |
Liver disease | 24 (8%) | 10 (5.6%) | 14 (11.3%) | 0.072 | 7 (5.6%) | 0.62 |
Chronic kidney disease | 52 (17.3%) | 25 (14.2%) | 27 (21.8%) | 0.087 | 33 (26.2%) | 0.36 |
Diabetes mellitus | 51 (17%) | 36 (20.3%) | 15 (12%) | 0.0001 | 27 (21.4%) | 0.28 |
Cerebrovascular disease | 32 (10.6%) | 20 (11.3%) | 12 (9.7%) | 0.65 | 68 (54%) | <0.0001 |
SOFA ≥ 2 | 252 (83.7%) | 140 (79%) | 112 (90.3%) | 0.009 | 71 (56%) | <0.0001 |
q-SOFA ≥ 2 | 21 (7%) | 7 (4%) | 14 (11.3%) | 0.015 | 1 (0.8%) | 0.0084 |
PCT, median [IQR] | 1.4 [0.37–6.7] | 0.97 [0.3–4.7] | 2.5 [0.7–12.8] | 0.0001 | 0.10 [0.05–0.3] | <0.0001 |
MR-proADM, median [IQR] | 2.5 [1.6–4.3] | 2.12 [1.4–3.2] | 3.65 [2.0–6.4] | <0.0001 | 1.19 [0.84–1.87] | <0.0001 |
Acute heart failure (%) | 100 (33.2%) | 44 (24.9%) | 56 (45.2%) | 0.0002 | 56 (44.4%) | 0.028 |
AKI (%) | 161 (53.7%) | 80 (49.7%) | 81 (65.3%) | 0.0074 | 29 (23%) | <0.0001 |
Acute liver injury (%) | 50 (16.6%) | 26 (14.7%) | 24 (19.4%) | 0.28 | 6 (4.7%) | 0.0009 |
ARDS (%) | 128 (42.5%) | 58 (32.8%) | 70 (56.5%) | <0.0001 | 40 (31.7%) | 0.037 |
GCS < 15 (%) | 157 (52.2%) | 77 (45.5%) | 80 (64.5%) | 0.0012 | 0 (0%) | <0.0001 |
Organ damage | ||||||
Score 0 | 38 (12.6%) | 28 (15.8%) | 10 (8%) | 0.045 | 25 (19.8%) | 0.056 |
Score 1 | 78 (26%) | 63 (35.6%) | 15 (12%) | <0.0001 | 41 (32.5%) | 0.172 |
Score ≥ 2 | 185 (61.4%) | 86 (48.6%) | 99 (80%) | <0.0001 | 60 (47.6%) | 0.0086 |
MR-proADM ≥ 2 | 168 (55.8%) | 83(46.9%) | 86 (69.3%) | 0.0001 | 29 (23.0%) | <0.0001 |
MR-proADM ≥ 3 | 111(36.8%) | 46 (25.9%) | 66 (53.2%) | <0.0001 | 11 (8.73%) | <0.0001 |
Need of ICU transfer, n (%) | 66 (21.9%) | 28 (15.8%) | 38 (30.6) | 0.0023 | 0 (0%) | <0.0001 |
LOS median [IQR]) | 15 [10.5–26.5] | 15 [8.2–36.2] | 17 [11.0–26.0] | 0.83 | 10 [8.0–13.0] | <0.0001 |
Mortality, n (%) | 79 (26.2%) | 27 (15.3%) | 52 (42%) | <0.0001 | 0 (0%) | <0.0001 |
MR-proADM ≥ 2 ng/mL | Odds Ratio | IC | p |
Multiple organ failure | 3.2964 | 2.0094 to 5.4078 | <0.0001 |
AKI | 3.4857 | 2.1153 to 5.7439 | <0.0001 |
Anemia | 2.4559 | 1.1582 to 5.2073 | 0.019 |
GCS < 15 | 2.0878 | 1.2897 to 3.3798 | 0.0027 |
ARDS | 1.8679 | 1.1407 to 3.0587 | 0.013 |
ICU transfer | 1.9091 | 1.0384 to 3.5096 | 0.037 |
Need for catecholamine | 2.5276 | 1.4197 to 4.5001 | 0.001 |
q-SOFA score ≥ 2 | ns * | ns | ns |
SOFA score ≥ 2 | 5.6863 | 3.3395 to 9.6821 | <0.0001 |
Septic shock | 2.4959 | 1.4965 to 4.1626 | 0.0005 |
AHF | 1.8506 | 1.0947 to 3.1284 | 0.022 |
Acute liver failure | ns | ns | ns |
MR-proADM ≥ 3 ng/mL | Odds ratio | IC | p |
Multiple organ failure | 2.2130 | 1.3772 to 3.5559 | 0.0010 |
AKI | 2.0689 | 1.3052 to 3.2793 | 0.0020 |
Anemia | 2.3646 | 1.0731 to 5.2104 | 0.0328 |
GCS < 15 | 2.2720 | 1.4316 to 3.6056 | 0.0005 |
ARDS | 1.8222 | 1.1469 to 2.8950 | 0.0111 |
ICU transfer | ns | ns | ns |
Need for catecholamine | 2.7650 | 1.6373 to 4.6693 | 0.0001 |
q-SOFA score ≥ 2 | ns | ns | ns |
SOFA score ≥ 2 | 3.9315 | 2.3094 to 6.6930 | <0.0001 |
Septic shock | 2.4435 | 1.5235 to 3.9192 | 0.0002 |
AHF | ns | ns | ns |
Acute liver failure | ns | ns | ns |
MR-proADM ≥ 2 ng/mL | Odds Ratio | IC | p |
Multiple organ failure | ns * | ns | ns |
AKI | 3.3300 | 1.7301 to 6.4093 | 0.0003 |
Anemia | 2.5228 | 1.0561 to 6.0265 | 0.0373 |
GCS | ns | ns | ns |
ARDS | ns | ns | ns |
ICU transfer | ns | ns | ns |
Need for catecholamine | ns | ns | ns |
q-SOFA score ≥ 2 | ns | ns | ns |
SOFA score ≥ 2 | 4.1487 | 2.2255 to 7.7341 | <0.0001 |
Septic shock | ns | ns | ns |
AHF | ns | ns | ns |
Acute liver failure | ns | ns | ns |
MR-proADM ≥ 3 ng/mL | Odds ratio | IC | p |
Multiple organ failure | ns | ns | ns |
AKI | 2.1161 | 1.1605 to 3.8586 | 0.0145 |
Anemia | ns | ns | ns |
GCS < 15 | 2.1025 | 0.8989 to 4.9174 | 0.034 |
ARDS | ns | ns | ns |
ICU transfer | ns | ns | ns |
Need for catecholamine | ns | ns | ns |
q-SOFA score ≥ 2 | ns | ns | ns |
SOFA score ≥ 2 | 2.4078 | 1.3021 to 4.4526 | 0.0051 |
Septic shock | ns | ns | ns |
AHF | ns | ns | ns |
Acute liver failure | ns | ns | ns |
30-Day Mortality | Odds Ratio | IC | p |
Multiple organ failure | 3.2617 | 1.4581 to 7.2966 | 0.0040 |
AKI | 2.3622 | 1.1786 to 4.7343 | 0.0154 |
Anemia | ns * | ns | ns |
GCS < 15 | 5.0579 | 2.2629 to 11.3050 | 0.0001 |
ARDS | 2.4531 | 1.2724 to 4.7294 | 0.0074 |
ICU transfer | 4.9762 | 2.5408 to 9.7461 | <0.0001 |
Need for cathecolamine | 7.3522 | 3.6562 to 14.7843 | <0.0001 |
q-SOFA score ≥ 2 | ns | ns | ns |
SOFA score ≥ 2 | 11.3174 | 2.6773 to 47.8394 | 0.0010 |
Septic shock | 6.3089 | 2.9794 to 13.3589 | <0.0001 |
AHF | ns | ns | ns |
Liver failure | ns | ns | ns |
MR-proADM ≥ 2 ng/mL | 3.9317 | 1.7715 to 8.7264 | 0.0008 |
MR-proADM ≥ 3 ng/mL | 3.9429 | 1.8690 to 8.3179 | 0.0003 |
90-Day Mortality | Odds Ratio | IC | p |
Multiple organ failure | 4.5778 | 2.1360 to 9.8108 | 0.0001 |
AKI | 2.5213 | 1.3388 to 4.7481 | 0.0042 |
Anemia | ns | ns | ns |
GCS <15 | 6.2588 | 3.0631 to 12.7888 | <0.0001 |
ARDS | 2.7929 | 1.5179 to 5.1387 | 0.0010 |
ICU transfer | 5.8121 | 3.0097 to 11.2242 | <0.0001 |
Need for catecholamine | 4.7885 | 2.5684 to 8.9276 | <0.0001 |
q-SOFA score ≥ 2 | ns | ns | ns |
SOFA score ≥ 2 | 15.9779 | 3.7925 to 67.3158 | 0.0002 |
Septic shock | 3.8559 | 2.0438 to 7.2744 | <0.0001 |
AHF | ns | ns | ns |
Acute liver failure | ns | ns | ns |
MR-proADM ≥ 2 ng/mL | 3.9317 | 1.7715 to 8.7264 | 0.0008 |
MR-proADM ≥ 3 ng/mL | 3.6742 | 1.8678 to 7.2276 | 0.0002 |
30-Day Mortality | Odds Ratio | IC | p |
Multiple organ failure | ns * | ns | ns |
AKI | 3.4656 | 1.2347 to 9.7274 | 0.0183 |
Anemia | ns | ns | ns |
GCS < 15 | 5.1476 | 1.6979 to 15.6061 | 0.0038 |
ARDS | ns | ns | ns |
ICU transfer | 4.6601 | 1.9889 to 10.9190 | 0.0004 |
Need for catecholamine | 4.3769 | 1.4054 to 13.6316 | 0.0109 |
q-SOFA score ≥ 2 | ns | ns | ns |
SOFA score ≥ 2 | ns | ns | ns |
Septic shock | ns | ns | ns |
AHF | ns | ns | ns |
Acute liver failure | ns | ns | ns |
MR-proADM ≥ 2 ng/mL | ns | ns | ns |
MR-proADM ≥ 3 ng/mL | ns | ns | ns |
90-Day Mortality | Odds Ratio | IC | p |
Multiple organ failure | ns | ns | ns |
AKI | 3.7243 | 1.4342 to 9.6714 | 0.0069 |
Anemia | ns | ns | ns |
GCS < 15 | 4.2173 | 1.5692 to 11.3338 | 0.0043 |
ARDS | ns | ns | ns |
ICU transfer | 6.1198 | 2.5688 to 14.5795 | <0.0001 |
Need for catecholamine | ns | ns | ns |
q-SOFA score ≥ 2 | ns | ns | ns |
SOFA score ≥ 2 | ns | ns | ns |
Septic shock | ns | ns | ns |
AHF | ns | ns | ns |
Acute liver failure | ns | ns | ns |
MR-proADM ≥ 2 ng/mL | ns | ns | ns |
MR-proADM ≥ 3 ng/mL | ns | ns | ns |
30-Day Mortality | Odds Ratio | IC | p |
Multiple organ failure | 0.1366 | 0.0247 to 0.7550 | 0.0225 |
AKI | 3.2293 | 1.0380 to 10.0464 | 0.0429 |
RIFLE (E and F) | 3.3287 | 1.0041 to 11.0349 | 0.0492 |
Anemia | ns * | ns | ns |
GCS < 15 | 4.9128 | 1.4870 to 16.2308 | 0.0090 |
ARDS | ns | ns | ns |
ARDS grade 2 and 3 | ns | ns | ns |
ICU transfer | 7.1586 | 2.6683 to 19.2054 | 0.0001 |
Need for catecholamine | 3.9473 | 1.0845 to 14.3680 | 0.0373 |
q-SOFA score ≥ 2 | ns | ns | ns |
SOFA score ≥ 2 | ns | ns | ns |
Septic shock | ns | ns | ns |
AHF | ns | ns | ns |
Acute liver failure | ns | ns | ns |
90-Day Mortality | Odds Ratio | IC | p |
Multiple organ failure | ns | ns | ns |
AKI | 3.4156 | 1.2496 to 9.3360 | 0.0166 |
RIFLE (E and F) | ns | ns | ns |
Anemia | ns | ns | ns |
GCS < 15 | 4.3246 | 1.5959 to 11.7187 | 0.0040 |
ARDS | ns | ns | ns |
ARDS grade 2 and 3 | ns | ns | ns |
ICU transfer | 6.2453 | 2.5989 to 15.0078 | <0.0001 |
Need for catecholamine | ns | ns | ns |
q-SOFA score ≥ 2 | ns | ns | ns |
SOFA score ≥ 2 | 6.2167 | 1.2449 to 31.0450 | 0.0260 |
Septic shock | ns | ns | ns |
AHF | ns | ns | ns |
Acute liver failure | ns | ns | ns |
MR-proADM ≥ 1.4 ng/mL | Odds Ratio | IC | p |
---|---|---|---|
AKI | 11.9111 | 4.1181 to 34.4513 | <0.0001 |
Anemia | 4.3343 | 1.8871 to 9.9551 | 0.0005 |
ARDS | ns * | ns | ns |
q-SOFA score ≥ 2 | ns | ns | ns |
SOFA score ≥ 2 | 2.7206 | 1.2037 to 6.1492 | 0.0161 |
AHF | 4.1355 | 1.9212 to 8.9023 | 0.0003 |
Acute liver failure | ns | ns | ns |
MR-proADM ≥ 1.4 ng/mL | Odds Ratio | IC | p |
---|---|---|---|
AKI | 5.2434 | 1.6331 to 16.8349 | 0.0054 |
Anemia | 2.8312 | 1.0660 to 7.5197 | 0.0368 |
ARDS | ns * | ns | ns |
q-SOFA score ≥ 2 | ns | ns | ns |
SOFA score ≥ 2 | 1.9625 | 0.6955 to 5.5374 | 0.2027 |
AHF | 3.2017 | 1.2562 to 8.1601 | 0.0148 |
Acute liver failure | ns | ns | ns |
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Spoto, S.; Basili, S.; Cangemi, R.; D’Avanzo, G.; Lupoi, D.M.; Romiti, G.F.; Argemi, J.; Yuste, J.R.; Lucena, F.; Locorriere, L.; et al. Mid-Regional Pro-Adrenomedullin Can Predict Organ Failure and Prognosis in Sepsis? Int. J. Mol. Sci. 2023, 24, 17429. https://doi.org/10.3390/ijms242417429
Spoto S, Basili S, Cangemi R, D’Avanzo G, Lupoi DM, Romiti GF, Argemi J, Yuste JR, Lucena F, Locorriere L, et al. Mid-Regional Pro-Adrenomedullin Can Predict Organ Failure and Prognosis in Sepsis? International Journal of Molecular Sciences. 2023; 24(24):17429. https://doi.org/10.3390/ijms242417429
Chicago/Turabian StyleSpoto, Silvia, Stefania Basili, Roberto Cangemi, Giorgio D’Avanzo, Domenica Marika Lupoi, Giulio Francesco Romiti, Josepmaria Argemi, José Ramón Yuste, Felipe Lucena, Luciana Locorriere, and et al. 2023. "Mid-Regional Pro-Adrenomedullin Can Predict Organ Failure and Prognosis in Sepsis?" International Journal of Molecular Sciences 24, no. 24: 17429. https://doi.org/10.3390/ijms242417429