Ajith Kumar A K
Department of Critical Care, Manipal Hospitals, Bengaluru, Karnataka, India.
Indian J Crit Care Med. 2020 Dec;24(12):1151-1153. doi: 10.5005/jp-journals-10071-23669.
Adrenomedullin (ADM) is a 52 amino acid containing free circulating vasoactive peptide hormone found to be active in various pathophysiological states including sepsis. High ADM levels at admission have been correlated with vasopressor requirements, organ dysfunction, and mortality in sepsis patients. ADM stimulation results in vasodilation and loss of vascular resistance in humans resulting in hypotension with the potential for negative impact in septic shock. However, human and animal experiments have shown that ADM decreases hyperpermeability and capillary leak, thus having an endothelial barrier stabilizing effect during septic shock. Adrenomedullin thus appears to be a double-edged weapon. This editorial critically reviews the article by Daga et al. who evaluated serum ADM as a prognostic marker to review the gender-related difference in mortality pattern, and also the correlation of ADM level to APACHE II and SOFA scores. The role of adrenomedullin in sepsis and the potential developments in the future have been discussed concisely. Ajith Kumar AK. Adrenomedullin in Sepsis: Finally, a Friend or an Enemy? Indian J Crit Care Med 2020;24(12):1151-1153.
肾上腺髓质素（ADM）是一种含52个氨基酸的可自由循环的血管活性肽激素，发现在包括脓毒症在内的各种病理生理状态下具有活性。脓毒症患者入院时ADM水平升高与血管活性药物需求、器官功能障碍及死亡率相关。ADM刺激可导致人体血管舒张和血管阻力降低，从而引起低血压，这在感染性休克中可能产生负面影响。然而，人体和动物实验表明，ADM可降低高通透性和毛细血管渗漏，因此在感染性休克期间具有稳定内皮屏障的作用。肾上腺髓质素似乎是一把双刃剑。本社论对Daga等人的文章进行了批判性综述，他们评估血清ADM作为预后标志物，以审视死亡率模式中的性别差异，以及ADM水平与急性生理与慢性健康状况评分系统（APACHE II）和序贯器官衰竭评估（SOFA）评分的相关性。本文简要讨论了肾上腺髓质素在脓毒症中的作用以及未来的潜在发展。Ajith Kumar AK。脓毒症中的肾上腺髓质素：最终，是朋友还是敌人？《印度重症监护医学杂志》2020年；24(12):1151 - 1153。
