Daga Mradul K, Kumar Lalit, Mawari Govind, Kumar Naresh, Singh Shashank, Mishra Tarun Kumar
Department of Medicine, Maulana Azad Medical College, New Delhi, India.
Department of Biochemistry, Maulana Azad Medical College, New Delhi, India.
Indian J Crit Care Med. 2020 Dec;24(12):1180-1184. doi: 10.5005/jp-journals-10071-23672.
Serum adrenomedullin (ADM) as a prognostic biomarker to study the gender-related differences in mortality pattern and its correlation with the sequential organ failure assessment (SOFA) and acute physiologic assessment and chronic health evaluation II (APACHE II) scores in patients of sepsis.
Eighty patients of sepsis of which 36 were males and 44 were females, were taken in the study as per sepsis III guidelines. They were followed up for a period of 28 days. Serum ADM was measured on day 1 and day 5. The endpoint was mortality or survival at day 28 after admission. The death rate among males was higher, with 23 of the total 36 (63.89%) patients having died when compared with females in which 25 patients out of 44 (56.82%) had died. The observed mortality rates correlated well with average APACHE II scores. The average APACHE II score was slightly higher in males (29 ± 8.97) when compared with females (27.02 ± 8.69). Similarly, day 1 SOFA and mean SOFA values were higher in males (10.22 ± 5.36) and (10.73 ± 6.01) when compared with females (8.27 ± 4.79) and (8.89 ± 5.6), respectively. Males despite having higher mortality rates, higher APACHE II, SOFA, and mean SOFA values were still having less mean levels of serum ADM (454.40 ± 81.13 pg/mL) when compared with females (479.62 ± 126.97 pg/mL).
Adrenomedullin is a protective neurohormone with antibacterial and anti-inflammatory properties. It is elevated in all patients with sepsis but the rise is more so in the female when compared with males. Higher ADM levels in females may suggest the protective effect of ADM as a part of the general protective neurohormonal stress response, which may explain the low death rate in females in sepsis.
Daga MK, Kumar L, Mawari G, Kumar N, Singh S, Mishra TK. Adrenomedullin and Its Possible Role in Improved Survival in Female Patients with Sepsis: A Study in the South East Asian Region. Indian J Crit Care Med 2020;24(12):1180-1184.
研究血清肾上腺髓质素（ADM）作为一种预后生物标志物，在脓毒症患者中探讨死亡率模式的性别差异及其与序贯器官衰竭评估（SOFA）和急性生理与慢性健康状况评分系统II（APACHE II）评分的相关性。
根据脓毒症III指南，选取80例脓毒症患者进行研究，其中男性36例，女性44例。对他们进行为期28天的随访。在第1天和第5天测量血清ADM。终点为入院后第28天的死亡率或生存率。男性的死亡率较高，36例患者中有23例（63.89%）死亡，而女性44例中有25例（56.82%）死亡。观察到的死亡率与平均APACHE II评分密切相关。男性的平均APACHE II评分（29±8.97）略高于女性（27.02±8.69）。同样，男性第1天的SOFA和平均SOFA值（分别为10.22±5.36和10.73±6.01）高于女性（分别为8.27±4.79和8.89±5.6）。尽管男性死亡率较高、APACHE II、SOFA和平均SOFA值较高，但与女性（479.62±126.97 pg/mL）相比，男性血清ADM的平均水平仍较低（454.40±81.13 pg/mL）。
肾上腺髓质素是一种具有抗菌和抗炎特性的保护性神经激素。所有脓毒症患者的肾上腺髓质素水平均升高，但女性升高幅度大于男性。女性较高的ADM水平可能表明ADM作为一般保护性神经激素应激反应的一部分具有保护作用，这可能解释了脓毒症女性患者死亡率较低的原因。
Daga MK, Kumar L, Mawari G, Kumar N, Singh S, Mishra TK.肾上腺髓质素及其在提高脓毒症女性患者生存率中的可能作用：东南亚地区的一项研究。《印度重症监护医学杂志》2020；24(12):1180-1184。
