Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Berlin, Germany.
Department of Cardiology (Virchow Klinikum), Charité Universitätsmedizin Berlin and German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.
Sci Rep. 2023 Mar 24;13(1):4873. doi: 10.1038/s41598-023-30633-9.
An early and reliable prediction of outcomes after stroke is important for early effective stroke management and the adequate optimal planning of post-stroke rehabilitation and long-term care. Bioactive adrenomedullin (bio-ADM) is a 52-amino acid peptide that is an important peptide hormone in nervous system diseases. The aim of this study was to investigate the prognostic value of bio-ADM on outcomes after rehabilitation in patients with stroke. A total of 557 consecutive patients with a primary diagnosis of ischemic or hemorrhagic stroke (age 69.6-12.9 years, male 51.3%, ischemic stroke 72.5%), who were admitted to an in-patient early rehabilitation center directly after discharge from acute stroke hospital care, were enrolled in this prospective observational study. Plasma concentrations of bio-ADM were determined by using a chemiluminescence immunoassay (functional assay sensitivity 8 pg/ml). The early rehabilitation barthel index (ERBI) was used for the neurological assessment of the patients. The plasma bio-ADM level was analyzed in association with 6-month all-cause mortality as well as a composite outcome of all-cause mortality, unscheduled re-hospitalization, or transfer to a long-term care facility in a vegetative or minimally conscious state. Bio-ADM levels significantly increased in patients with ischemic stroke who died compared to surviving patients (40.4 pg/ml vs. 23.8 pg/ml, p < 0.001) or in those with composite outcomes compared to those with no events (36.9 pg/ml vs. 23.5 pg/ml, p < 0.001). Six-month all-cause mortality was higher in all patients with bio-ADM levels > 70 pg/ml (HR 4.83 [CI 2.28-10.2]). Patients with bio-ADM levels > 70 pg/ml also had higher rates of 6-month composite outcomes (HR 3.82 [CI 2.08-7.01]). Bio-ADM was an independent predictor of all-cause mortality and 6-month composite outcomes after adjusting for age, gender, and ERBI (adjusted OR 1.5; 95% CI 1.0-2.1; p = 0.047 and adjusted OR 1.48; 95% CI 1.1-2.0; p = 0.01, respectively). Bio-ADM may be a suitable novel biomarker to assess the outcomes of patients in rehabilitation after acute stroke. Elevated bio-ADM concentrations may have prognostic value for fatal and nonfatal events in patients with ischemic stroke during early rehabilitation.
生物活性肾上腺髓质素（bio-ADM）是一种 52 个氨基酸肽，是神经系统疾病中重要的肽类激素。本研究旨在探讨生物活性 ADM 对卒中后康复结局的预测价值。共纳入 557 例因缺血性或出血性卒中（年龄 69.6-12.9 岁，男性 51.3%，缺血性卒中 72.5%）而被直接从急性卒中医院护理出院后入住住院早期康复中心的连续患者。使用化学发光免疫测定法（功能测定灵敏度 8 pg/ml）测定生物活性 ADM 的血浆浓度。采用早期康复巴氏指数（ERBI）评估患者的神经功能。分析了血浆生物活性 ADM 水平与 6 个月全因死亡率以及全因死亡率、非计划性再住院或处于植物状态或最小意识状态的长期护理机构的组合结局之间的关系。与存活患者（40.4 pg/ml 比 23.8 pg/ml，p < 0.001）或复合结局患者（36.9 pg/ml 比 23.5 pg/ml，p < 0.001）相比，死于缺血性卒中的患者的生物活性 ADM 水平显着升高。所有患者中，生物活性 ADM 水平>70 pg/ml 的患者的 6 个月全因死亡率更高（HR 4.83 [CI 2.28-10.2]）。生物活性 ADM 水平>70 pg/ml 的患者 6 个月复合结局的发生率也更高（HR 3.82 [CI 2.08-7.01]）。在调整年龄、性别和 ERBI 后，生物活性 ADM 是全因死亡率和 6 个月复合结局的独立预测因子（调整 OR 1.5；95%CI 1.0-2.1；p = 0.047 和调整 OR 1.48；95%CI 1.1-2.0；p = 0.01）。生物活性 ADM 可能是评估急性卒中后康复患者结局的合适新型生物标志物。在早期康复期间，升高的生物活性 ADM 浓度可能对缺血性卒中患者的致命和非致命事件具有预后价值。
