Ann Lab Med 2019; 39(5): 454-463  https://doi.org/10.3343/alm.2019.39.5.454
Circulating Biologically Active Adrenomedullin Predicts Organ Failure and Mortality in Sepsis
Hanah Kim , M.D., Ph.D.1, Mina Hur , M.D., Ph.D.1, Joachim Struck , Ph.D.2, Andreas Bergmann , Ph.D.2, and Salvatore Di Somma , M.D., Ph.D.3
1Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Korea; 2Sphingotec GmbH, Hennigsdorf, Germany; 3Departments of Medical-Surgery Sciences and Translational Medicine, School of Medicine and Psychology, Sapienza – University, Sant’ Andrea Hospital, Rome, Italy
Corresponding author: Mina Hur, M.D., Ph.D.
Department of Laboratory Medicine, Konkuk University School of Medicine, Konkuk University Medical Center, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 05030, Korea
Tel: +82-2-2030-5581, Fax: +82-2-2636-6764, E-mail: dearmina@hanmail.net
Received: January 17, 2019; Revised: March 11, 2019; Accepted: April 19, 2019; Published online: September 1, 2019.
© Korean Society for Laboratory Medicine. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Biologically active adrenomedullin (bio-ADM) is an emerging biomarker for sepsis. We explored whether bio-ADM concentration could predict severity, organ failure, and 30-day mortality in septic patients.
Methods: In 215 septic patients (109 patients with sepsis; 106 patients with septic shock), bio-ADM concentration was measured at diagnosis of sepsis, using sphingotest bio-ADM (Sphingotec GmbH, Hennigsdorf, Germany) and analyzed in terms of sepsis severity, vasopressor use, and 30-day mortality. The number of organ failures, sequential (sepsis-related) organ failure assessment (SOFA) score, and 30-day mortality were compared according to bio-ADM quartiles.
Results: Bio-ADM concentration was significantly higher in patients with septic shock, vasopressor use, and non-survivors than in patients with solitary sepsis, no vasopressor use, and survivors, respectively (all P<0.0001). Bio-ADM quartiles were associated with the number of organ failures (P<0.0001), as well as SOFA cardiovascular, renal, coagulation, and liver subscores (all P<0.05). The 30-day mortality rate showed a stepwise increase in each bio-ADM quartile (all P<0.0001). Bio-ADM concentration and SOFA score equally predicted the 30-day mortality (area under the curve: 0.827 vs 0.830).
Conclusions: Bio-ADM could serve as a useful and objective biomarker to predict severity, organ failure, and 30-day mortality in septic patients.
Keywords: Bio-ADM, Sepsis, Organ failure, Mortality



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