Mid-regional pro-adrenomedillin can predict organ failure and prognosis in sepsis?

Resumen:
Sepsis causes immune dysregulation and endotheliitis, with an increase in mid-regional pro-adrenomedullin (MR-proADM). The aim of the study is to determine an MR-proADM value that, in addition to clinical diagnosis, can identify patients with localized infection or those with sepsis/septic shock, with specific organ damage or with the need for intensive care unit (ICU) transfer and prognosis. The secondary aim is to correlate the MR-proADM value with the length of stay (LOS). In total, 301 subjects with sepsis (124/301 with septic shock) and 126 with localized infection were retrospectively included. In sepsis, MR-proADM ¿ 3.39 ng/mL identified acute kidney injury (AKI); ¿2.99 ng/mL acute respiratory distress syndrome (ARDS); ¿2.28 ng/mL acute heart failure (AHF); ¿2.55 ng/mL Glascow Coma Scale (GCS) < 15; ¿3.38 multi-organ involvement; ¿3.33 need for ICU transfer; ¿2.0 Sequential Organ Failure Assessment (SOFA) score ¿ 2; and ¿3.15 ng/mL non-survivors. The multivariate analysis showed that MR-proADM ¿ 2 ng/mL correlates with AKI, anemia and SOFA score ¿ 2, and MR-proADM ¿ 3 ng/mL correlates with AKI, GCS < 15 and SOFA score ¿ 2. A correlation between mortality and AKI, GCS < 15, ICU transfer and cathecolamine administration was found. In localized infection, MR-proADM at admission ¿ 1.44 ng/mL identified patients with AKI; ¿1.0 ng/mL with AHF; and ¿1.44 ng/mL with anemia and SOFA score ¿ 2. In the multivariate analysis, MR-proADM ¿ 1.44 ng/mL correlated with AKI, anemia, SOFA score ¿ 2 and AHF. MR-proADM is a marker of oxidative stress due to an infection, reflecting severity proportionally to organ damage.