1 Department of Anesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany.
2 Department of Anesthesiology, University Hospital Heidelberg, Heidelberg, Germany.
J Intensive Care Med. 2019 Jan;34(1):67-76. doi: 10.1177/0885066616689554. Epub 2017 Jan 23.
: Patients undergoing vascular surgery are prone to perioperative organ injury because of both higher prevalence of cardiovascular risk factors and the extent of surgery. Early detection of organ failure is essential to facilitate appropriate medical care. Midregional pro-adrenomedullin (MR-proADM) has been investigated in acute medical care settings to guide clinical decision-making regarding patient pathways and to identify patients prone to imminent cardiovascular or inflammatory complications. In this study, we evaluated the impact of perioperative MR-proADM levels as an early marker of perioperative cardiovascular and inflammatory stress reactions and kidney injury.
: The study was conducted as a monocentric, prospective, noninterventional trial at Hannover Medical School, Germany. A total of 454 consecutive patients who underwent open vascular surgery were followed from the day prior to until 30 days after surgery. The composite primary end point was defined as the occurrence of major adverse cardiac events (MACEs), acute kidney injury (AKI), or systemic inflammatory response syndrome (SIRS). Measurements were correlated with both medical history and postoperative MACE, AKI, or SIRS using univariate and multivariate regression analysis.
: One hundred thirty-nine (31%) of the patients reached the primary end point within the study interval. Midregional pro-adrenomedullin change was associated with the combined primary end point and with the intensity of surgical trauma. Midregional pro-adrenomedullin change was increased in patients reaching the secondary end points, SIRS (optimal cutoff: 0.2 nmol/L) and AKI (optimal cutoff: 0.7 nmol/L), but not in patients with MACEs.
: Increased levels of MR-proADM within the perioperative setting (1) were linked to the invasiveness of surgery and (2) identified patients with ongoing loss of renal function. Increased MR-proADM levels may therefore identify a subgroup of patients prone to excessive cardiovascular stress but did not directly correlate with adverse cardiac events. Consistently low levels of MR-proADM may identify a subgroup of patients with acceptable low risk to guide discharge from high-density care units.
由于心血管危险因素的普遍存在和手术范围的扩大，接受血管外科手术的患者容易发生围手术期器官损伤。早期发现器官衰竭对于提供适当的医疗护理至关重要。中区域促肾上腺髓质素（MR-proADM）已在急性医疗保健环境中进行了研究，以指导有关患者途径的临床决策，并识别易发生即将发生的心血管或炎症并发症的患者。在这项研究中，我们评估了围手术期 MR-proADM 水平作为围手术期心血管和炎症应激反应以及肾脏损伤的早期标志物的影响。
该研究是在德国汉诺威医学院进行的一项单中心、前瞻性、非干预性试验。共有 454 例连续接受开放血管手术的患者从手术前一天一直随访到手术后 30 天。复合主要终点定义为主要不良心脏事件（MACE）、急性肾损伤（AKI）或全身炎症反应综合征（SIRS）的发生。使用单变量和多变量回归分析将测量值与病史以及术后 MACE、AKI 或 SIRS 相关联。
在研究期间，有 139 名（31％）患者达到了主要终点。中区域促肾上腺髓质素变化与复合主要终点和手术创伤强度相关。达到次要终点（SIRS 的最佳截断值为 0.2 nmol/L，AKI 的最佳截断值为 0.7 nmol/L）的患者的中区域促肾上腺髓质素变化增加，但达到 MACE 的患者则没有。
围手术期内 MR-proADM 水平升高（1）与手术的侵袭性有关，（2）确定了持续发生肾功能丧失的患者。因此，MR-proADM 水平升高可能识别出易发生过度心血管应激的患者亚组，但与不良心脏事件没有直接相关性。MR-proADM 水平持续较低可能识别出一组风险可接受低的患者，以指导从高密度护理单元出院。
