Self Wesley H, Storrow Alan B, Hartmann Oliver, Barrett Tyler W, Fermann Gregory J, Maisel Alan S, Struck Joachim, Bergmann Andreas, Collins Sean P
Department of Emergency Medicine, Vanderbilt University, Nashville, TN, USA.
Department of Emergency Medicine, Vanderbilt University, Nashville, TN, USA.
Am J Emerg Med. 2016 Feb;34(2):257-62. doi: 10.1016/j.ajem.2015.10.033. Epub 2015 Oct 24.
The objective was to evaluate the prognostic performance of a new biomarker, plasma bioactive adrenomedullin (bio-ADM), for short-term clinical outcomes in acute heart failure.
A multicenter prospective cohort study of adult emergency department (ED) patients suspected of having acute heart failure was conducted to evaluate the association between plasma bio-ADM concentration and clinical outcomes. The primary outcome was a composite of the following within 30 days: death, cardiac arrest with resuscitation, respiratory failure, emergency dialysis, acute coronary syndrome, hospitalization >5 days, and repeat ED visit or hospitalization. Prognostic accuracy was evaluated with a nonparametric receiver operating characteristic curve. In addition, a multivariable logistic regression model was constructed to assess the additive prognostic performance of bio-ADM while adjusting for other biomarkers routinely used clinically, including B-type natriuretic peptide, cardiac troponin I, creatinine, and sodium concentration.
Two hundred forty-six patients were enrolled, including 85 (34.6%) patients with the primary outcome. Plasma bio-ADM concentrations were higher among patients who experienced the primary outcome (median, 80.5 pg/mL; interquartile range [IQR], 53.7-151.5 pg/mL) compared with those who did not (median, 54.4 pg/mL; IQR, 43.4-78.4 pg/mL) (P < .01). Area under the receiver operating characteristic curve was 0.70 (95% confidence interval, 0.63-0.75). After adjusting for the other biomarkers, plasma bio-ADM remained a strong predictor of the primary outcome (adjusted odds ratio per IQR change, 2.68; 95% confidence interval, 1.60-4.51).
Bioactive adrenomedullin concentrations at the time of ED evaluation for acute heart failure were predictive of clinically important 30-day outcomes, suggesting that bio-ADM is a promising prognostic marker for further study.
评估一种新的生物标志物——血浆生物活性肾上腺髓质素（bio-ADM）对急性心力衰竭短期临床结局的预后评估性能。
开展一项针对疑似急性心力衰竭的成年急诊科（ED）患者的多中心前瞻性队列研究，以评估血浆bio-ADM浓度与临床结局之间的关联。主要结局为30天内以下情况的复合事件：死亡、心肺复苏成功的心脏骤停、呼吸衰竭、紧急透析、急性冠状动脉综合征、住院时间>5天以及再次急诊就诊或住院。采用非参数受试者工作特征曲线评估预后准确性。此外，构建多变量逻辑回归模型，在调整其他临床常规使用的生物标志物（包括B型利钠肽、心肌肌钙蛋白I、肌酐和钠浓度）的同时，评估bio-ADM的附加预后性能。
共纳入246例患者，其中85例（34.6%）出现主要结局。出现主要结局的患者血浆bio-ADM浓度高于未出现主要结局的患者（中位数，80.5 pg/mL；四分位间距[IQR]，53.7 - 151.5 pg/mL），而未出现主要结局的患者血浆bio-ADM浓度中位数为54.4 pg/mL；IQR为43.4 - 78.4 pg/mL（P <.01）。受试者工作特征曲线下面积为0.70（95%置信区间，0.63 - 0.75）。在调整其他生物标志物后，血浆bio-ADM仍然是主要结局的有力预测指标（每IQR变化的调整优势比为2.68；95%置信区间，1.60 - 4.51）。
急性心力衰竭急诊评估时的生物活性肾上腺髓质素浓度可预测30天内具有临床意义的结局，提示bio-ADM是一个有前景的预后标志物，值得进一步研究。
