Departments of Anesthesiology and Intensive Care Unit, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
Research and Development Management, Bioscience Division, TOSOH Corporation, Kanagawa, Japan.
Anaesthesiol Intensive Ther. 2021;53(5):411-417. doi: 10.5114/ait.2021.111345.
Information about biologically active adrenomedullin (mature AM), a potential new biomarker for sepsis and septic shock, is limited. Here, we investigated the value of mature AM for diagnosis and outcome prediction in sepsis.
Patients admitted to the intensive care unit (ICU) were retrospectively cate-gorised into non-sepsis or sepsis groups, according to the Sepsis-3 definitions. Plasma levels of mature and total (the sum of the levels of intermediate and mature forms) AM were measured, and their usefulness was compared with that of other sepsis biomarkers, such as procalcitonin and presepsin.
Of the 98 patients analysed, 42 were assigned to the non-sepsis and 56 to the sepsis group. Mature and total AM levels on admission were significantly higher in patients with than in those without sepsis. The areas under the receiver operating characteristic curves (AUCs) of mature and total AM for diagnosing sepsis were 0.85 and 0.88, whereas those of procalcitonin and presepsin were 0.83 and 0.68, respectively. AUCs of mature and total AM for predicting 28-day mortality in patients with sepsis became significant on day 3 after admission. A good correlation between the AM forms was found, indicating that changes in their plasma levels may directly reflect each other.
Because mature and total AM levels increased significantly in patients with sepsis on admission, both forms may be used as reliable and early biomarkers for diagnosing sepsis according to the Sepsis-3 definitions. However, prediction of 28-day mortality in such patients would require several days of ICU stay.
有关生物活性肾上腺髓质素（成熟 AM）的信息有限，成熟 AM 是脓毒症和脓毒性休克的一个潜在新生物标志物。在此，我们研究了成熟 AM 对脓毒症的诊断和预后预测的价值。
根据 Sepsis-3 定义，回顾性地将入住重症监护病房（ICU）的患者分为非脓毒症或脓毒症组。测量了血浆中成熟和总 AM（中间和成熟形式水平的总和）的水平，并将其与其他脓毒症生物标志物（如降钙素原和前降钙素）的有用性进行了比较。
在分析的 98 例患者中，42 例被分配到非脓毒症组，56 例被分配到脓毒症组。入院时患有脓毒症的患者的成熟和总 AM 水平明显高于没有脓毒症的患者。成熟和总 AM 诊断脓毒症的受试者工作特征曲线（AUC）的 AUC 分别为 0.85 和 0.88，而降钙素原和前降钙素的 AUC 分别为 0.83 和 0.68。入院后第 3 天，成熟和总 AM 预测脓毒症患者 28 天死亡率的 AUC 变得有意义。发现 AM 形式之间存在良好的相关性，表明其血浆水平的变化可能直接相互反映。
由于入院时患有脓毒症的患者成熟和总 AM 水平显着增加，因此根据 Sepsis-3 定义，这两种形式都可以用作可靠的早期脓毒症生物标志物。然而，此类患者 28 天死亡率的预测需要几天的 ICU 住院时间。
