Pervez Mohammad Osman, Lyngbakken Magnus Nakrem, Myhre Peder Langeland, Brynildsen Jon, Langsjøen Eva Camilla, Høiseth Arne Didrik, Christensen Geir, Omland Torbjørn, Røsjø Helge
Division of Medicine, Akershus University Hospital, Lørenskog, Norway; Center for Heart Failure Research, University of Oslo, Oslo, Norway.
Section for Medical Biochemistry, Division of Diagnostics and Technology, Akershus University Hospital, Lørenskog, Norway.
Clin Biochem. 2017 May;50(7-8):394-400. doi: 10.1016/j.clinbiochem.2016.12.010. Epub 2017 Jan 5.
Mid-regional pro-adrenomedullin (MR-proADM) is a surrogate marker for adrenomedullin; a hormone that attenuates myocardial remodeling. Accordingly, we hypothesized that MR-proADM could provide diagnostic and prognostic information in patients with acute dyspnea.
We measured MR-proADM by a commercial ELISA on hospital admission in 311 patients with acute dyspnea and compared the utility of MR-proADM with N-terminal pro-B-type natriuretic peptide (NT-proBNP). Blood samples were also available after 24h (n=232) and before discharge (n=94). The principal diagnosis of the index hospitalization was determined by an adjudication committee. MR-proADM concentrations on hospital admission were higher in patients with acute heart failure (HF; n=143) vs. patients hospitalized with non-HF-related dyspnea (n=168): 1.31 (Q1-3 0.97-1.89) vs. 0.85 (0.59-1.15) nmol/L; p<0.001. The receiver-operating characteristics area under the curve (ROC-AUC) for MR-proADM to diagnose HF was 0.77 (95% CI 0.72-0.82) and 0.86 (0.82-0.90) for NT-proBNP. During a median follow-up of 816days, 66/143 patients (46%) with acute HF and 35/84 patients (42%) with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) died; p=0.58 between groups. In multivariate Cox regression analyses, admission MR-proADM concentrations were associated with mortality in patients with acute HF (HR 5.90 [3.43-10.13], p<0.001), but not in patients with AECOPD. Admission MR-proADM concentrations also improved risk stratification in acute HF as assessed by the net reclassification index. MR-proADM concentrations decreased from admission to later time points.
Admission MR-proADM concentrations provide strong prognostic information in patients with acute HF, but modest diagnostic information in patients with acute dyspnea.
中段肾上腺髓质素原（MR-proADM）是肾上腺髓质素的替代标志物；肾上腺髓质素是一种可减轻心肌重塑的激素。因此，我们推测MR-proADM可为急性呼吸困难患者提供诊断和预后信息。
我们采用商用酶联免疫吸附测定法（ELISA）在311例急性呼吸困难患者入院时检测了MR-proADM，并将MR-proADM与N末端B型利钠肽原（NT-proBNP）的效用进行了比较。24小时后（n = 232）和出院前（n = 94）也采集了血样。索引住院的主要诊断由一个裁决委员会确定。急性心力衰竭（HF；n = 143）患者入院时的MR-proADM浓度高于因非HF相关呼吸困难住院的患者（n = 168）：分别为1.31（四分位间距0.97 - 1.89）和0.85（0.59 - 1.15）nmol/L；p < 0.001。MR-proADM诊断HF的受试者操作特征曲线下面积（ROC-AUC）为0.77（95%可信区间0.72 - 0.82），NT-proBNP为0.86（0.82 - 0.90）。在中位随访816天期间，143例急性HF患者中有66例（46%）和84例慢性阻塞性肺疾病急性加重（AECOPD）患者中有35例（42%）死亡；两组间p = 0.58。在多变量Cox回归分析中，入院时的MR-proADM浓度与急性HF患者的死亡率相关（风险比5.90 [3.43 - 10.13]，p < 0.001），但与AECOPD患者无关。如通过净重新分类指数评估，入院时的MR-proADM浓度也改善了急性HF的风险分层。MR-proADM浓度从入院到后期时间点下降。
入院时的MR-proADM浓度可为急性HF患者提供有力的预后信息，但为急性呼吸困难患者提供的诊断信息有限。
