Odermatt Jonas, Meili Marc, Hersberger Lara, Bolliger Rebekka, Christ-Crain Mirjam, Briel Matthias, Bucher Heiner C, Mueller Beat, Schuetz Philipp
Department of Endocrinology, Diabetology and Metabolism, Medical University Clinic, Kantonsspital Aarau and University of Basel, Switzerland, Tellstrasse, CH-5001, Aarau, Switzerland.
Department of Endocrinology, Diabetology and Metabolism, Department of Clinical Research, University Hospital Basel, Basel, Switzerland.
BMC Cardiovasc Disord. 2017 Jul 4;17(1):178. doi: 10.1186/s12872-017-0605-3.
Several studies found mid-regional pro-adrenomedullin (ProADM), the prohormone of the cardiovascular protein adrenomedullin, to be strongly associated with short-term mortality, mostly in the inpatient setting. We evaluated associations of ProADM levels with 10-year mortality in community-dwelling primary care patients with respiratory tract infections.
This is a post-hoc analysis using clinical and biomarker data of 134 primary care patients with respiratory tract infections. ProADM was measured on admission and after 7 days in batch-analysis. 10-year follow-up data was collected by GP, patient and relative tracing through phone interviews. We calculated Cox regression models and area under the receiver operating characteristics curves to assess associations of ProADM with 10-year all-cause mortality.
During the 10-year follow-up 6% of included patients died. Median baseline ProADM blood levels (nmol/l) were significantly higher in non-survivors compared to survivors (0.5, IQR 0.4-1.3; vs. 0.2, IQR 0.1-0.5; p = 0.02) and showed a significant association with 10-year all-cause mortality in an age-adjusted cox regression model (HR: 2.5, 95%-CI: 1.0-6.1, p = 0.04). ProADM levels on day 7 showed similar results.
This posthoc analysis found an association of elevated ProADM blood levels and 10-year all-cause mortality in a primary care cohort with respiratory tract infections. Due to the methodological limitations including incomplete data regarding follow-up information and biomarker measurement, this study warrants validation in future larger studies.
Current Controlled Trials, SRCTN73182671.
多项研究发现，心血管蛋白肾上腺髓质素的前体激素——中段肾上腺髓质素原（ProADM）与短期死亡率密切相关，主要是在住院患者中。我们评估了社区初级保健呼吸道感染患者的ProADM水平与10年死亡率之间的关联。
这是一项事后分析，使用了134例初级保健呼吸道感染患者的临床和生物标志物数据。入院时和7天后通过批量分析测定ProADM。通过全科医生、患者及亲属电话随访收集10年随访数据。我们计算了Cox回归模型和受试者工作特征曲线下面积，以评估ProADM与10年全因死亡率之间的关联。
在10年随访期间，6%的纳入患者死亡。非幸存者的基线ProADM血液水平中位数（nmol/l）显著高于幸存者（0.5，四分位数间距0.4 - 1.3；对比0.2，四分位数间距0.1 - 0.5；p = 0.02），并且在年龄调整的Cox回归模型中与10年全因死亡率显示出显著关联（风险比：2.5，95%置信区间：1.0 - 6.1，p = 0.04）。第7天的ProADM水平显示出类似结果。
这项事后分析发现，在患有呼吸道感染的初级保健队列中，ProADM血液水平升高与10年全因死亡率之间存在关联。由于包括随访信息和生物标志物测量数据不完整在内的方法学局限性，本研究有待未来更大规模的研究进行验证。
当前对照试验，SRCTN73182671。
