Tirlangi Praveen Kumar, Ravindra Prithvishree, Bhat Rachana, Shenoy Belle Vijetha, Chaudhuri Souvik, Bhat Ashwitha, Acharya Poojashree, Gupta Nitin
Department of Infectious Diseases, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India.
Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India.
Am J Trop Med Hyg. 2024 Oct 8;111(6):1338-1342. doi: 10.4269/ajtmh.24-0301. Print 2024 Dec 4.
Acute febrile illnesses (AFI) such as dengue, leptospirosis, and scrub typhus start with fever, but some patients can deteriorate rapidly. Identifying these patients at risk is necessary to ensure early referral. The study's objective was to assess the utility of serum adrenomedullin (ADM) as a biomarker in predicting outcomes in adult AFI patients presenting to the emergency department (ED). In this prospective observational study, all consecutive patients admitted with AFI through the ED between June 2023 and February 2024 were assessed for eligibility. Clinical and laboratory findings were noted. The serum samples sent routinely for biochemical tests were used to calculate ADM levels at admission and 48 hours later (whenever possible). Clinically relevant outcome variables were collected for all patients. The utility of ADM in predicting 7-day mortality was evaluated for primary outcome analysis using a stepwise binary logistic regression. A total of 181 patients were recruited, with dengue (n = 91, 50%) being the most common diagnosis. The median sequential organ failure assessment score at admission was 5 (IQR: 3-10). The 7-day mortality was 26 (14%, 95% CI: 9.3-19.5). The median admission ADM levels and difference in ADM levels at 48 hours were significantly higher in those who died by day 7. Adrenomedullin levels at admission were found to be an independent predictor of 7-day mortality (adjusted odds ratio: 1.002, 95% CI: 1.001-1.004, P = 0.005). High ADM levels can be used for early referral in patients with tropical AFI. There is a need to explore the utility of antibodies targeting ADM in clinical studies.
登革热、钩端螺旋体病和恙虫病等急性发热性疾病（AFI）起病时伴有发热，但部分患者病情可能迅速恶化。识别这些高危患者对于确保早期转诊至关重要。本研究的目的是评估血清肾上腺髓质素（ADM）作为生物标志物在预测急诊科（ED）就诊的成年AFI患者预后中的作用。在这项前瞻性观察研究中，对2023年6月至2024年2月期间通过急诊科连续收治的所有AFI患者进行了资格评估。记录了临床和实验室检查结果。将常规送检进行生化检测的血清样本用于计算入院时及48小时后（尽可能）的ADM水平。收集了所有患者的临床相关结局变量。采用逐步二元逻辑回归对ADM预测7天死亡率的效用进行主要结局分析。共招募了181例患者，其中登革热（n = 91，50%）是最常见的诊断。入院时序贯器官衰竭评估评分的中位数为5（四分位间距：3 - 10）。7天死亡率为26例（14%，95%置信区间：9.3 - 19.5）。在第7天死亡的患者中，入院时ADM水平的中位数及48小时时ADM水平的差异显著更高。发现入院时的肾上腺髓质素水平是7天死亡率的独立预测因素（调整后的优势比：1.002，95%置信区间：1.001 - 1.004，P = 0.005）。高ADM水平可用于热带AFI患者的早期转诊。有必要在临床研究中探索靶向ADM的抗体的效用。
