Kang Fu-xin, Wang Rui-lan, Yu Kang-long, Wei Qiao
Intensive Care Unit, Shanghai Jiaotong University Affiliated First People's Hospital, Shanghai 201620, China.
Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2008 Aug;20(8):452-5.
To assess the clinical value of pro-adrenomedullin (pro-ADM) in the prognosis and risk stratification in sepsis.
Fifty-one critically ill patients admitted to the intensive care unit (ICU) were prospectively stratified into four groups according to internationally recognized criteria: systemic inflammatory response syndrome (SIRS, 25 cases), sepsis (12 cases), severe sepsis (9 cases) and septic shock (5 cases). The levels of plasma pro-ADM was determined in every patient using a new sandwich immunoassay, and compared with procalcitonin (PCT), C-reactive protein (CRP) and interleukin-6 (IL-6), and the acute physiology and chronic health evaluation II (APACHE II) score.
(1) Median pro-ADM concentration was 0.34 microg/L for SIRS, 2.23 microg/L for sepsis, 4.57 microg/L for severe sepsis and 8.21 microg/L for septic shock. The plasma concentration of pro-ADM exhibited a gradual increase, and the median pro-ADM value was highest in the septic shock group (all P<0.05). (2) Compared with the other biomarkers, in the sepsis, severe sepsis and septic shock groups, the plasma concentration of pro-ADM and APACHE II score in the non-survivors was significantly higher than in the survivors (pro-ADM: 2.01 microg/L vs. 9.75 microg/L, APACHE II score: 23.44 scores vs. 38.21 scores, both P<0.05). (3) By the receiver operating characteristic (ROC) curve plot analysis of pro-ADM in sepsis, the area under the ROC curve for pro-ADM (0.87) in survivors was similar to the area under the ROC curve for PCT (0.81) and APACHE II score (0.81), and was significantly higher than the area under the ROC curve for CRP (0.53) and IL-6 (0.71).
The measurement of pro-ADM is a new and useful marker in sepsis prognosis and risk stratification.
评估前肾上腺髓质素（pro-ADM）在脓毒症预后及风险分层中的临床价值。
前瞻性地将51例入住重症监护病房（ICU）的危重症患者按照国际公认标准分为四组：全身炎症反应综合征（SIRS，25例）、脓毒症（12例）、严重脓毒症（9例）和脓毒性休克（5例）。采用新型夹心免疫分析法测定每位患者血浆pro-ADM水平，并与降钙素原（PCT）、C反应蛋白（CRP）、白细胞介素-6（IL-6）以及急性生理与慢性健康状况评分系统II（APACHE II）评分进行比较。
（1）SIRS组pro-ADM浓度中位数为0.34μg/L，脓毒症组为2.23μg/L，严重脓毒症组为4.57μg/L，脓毒性休克组为8.21μg/L。血浆pro-ADM浓度呈逐渐升高趋势，脓毒性休克组pro-ADM中位数最高（均P<0.05）。（2）与其他生物标志物相比，在脓毒症、严重脓毒症和脓毒性休克组中，非存活者的血浆pro-ADM浓度和APACHE II评分显著高于存活者（pro-ADM：2.01μg/L对9.75μg/L，APACHE II评分：23.44分对38.21分，均P<0.05）。（3）通过对脓毒症患者pro-ADM的受试者工作特征（ROC）曲线分析，存活者中pro-ADM的ROC曲线下面积（0.87）与PCT（0.81）和APACHE II评分（0.81）的ROC曲线下面积相似，且显著高于CRP（0.53）和IL-6（0.71）的ROC曲线下面积。
pro-ADM测定是脓毒症预后及风险分层的一项新型且有用的标志物。
