adrenomedullin and Nervous-System-Diseases

Following the SEPSIS-3 consensus, detection of organ failure as assessed by the SOFA (Sequential Organ Failure Assessment) score, is mandatory to detect sepsis. Calculating SOFA outside of the Intensive Care Unit (ICU) is challenging. The alternative in this scenario, the quick SOFA, is very specific but less sensible. Biomarkers could help to detect the presence of organ failure secondary to infection either in ICU and non-ICU settings.. We evaluated the ability of four biomarkers (C-Reactive protein (CRP), lactate, mid-regional proadrenomedullin (MR-proADM) and procalcitonin (PCT)) to detect each kind of organ failure considered in the SOFA in 213 patients with infection, sepsis or septic shock, by using multivariate regression analysis and calculation of the area under the receiver operating curve (AUROC).. In the multivariate analysis, MR-proADM was an independent predictor of five different failures (respiratory, coagulation, cardiovascular, neurological and renal). In turn, lactate predicted three (coagulation, cardiovascular and neurological) and PCT two (cardiovascular and renal). CRP did not predict any of the individual components of SOFA. The highest AUROCs were those of MR-proADM and PCT to detect cardiovascular (AUROC, CI95%): MR-proADM (0.82 [0.76-0.88]), PCT (0.81 [0.75-0.87] (P < .05) and renal failure: MR-proADM (0.87 [0.82-0.92]), PCT (0.81 [0.75-0.86]), (P < .05). None of the biomarkers tested was able to detect hepatic failure.. In patients with infection, MR-proADM was the biomarker detecting the largest number of SOFA score components, with the exception of hepatic failure.

Topics: Adrenomedullin; Aged; Aged, 80 and over; Area Under Curve; Blood Coagulation Disorders; C-Reactive Protein; Cardiovascular Diseases; Female; Heart Failure; Humans; Infections; Intensive Care Units; Lactic Acid; Liver Failure; Male; Middle Aged; Multivariate Analysis; Nervous System Diseases; Organ Dysfunction Scores; Peptide Fragments; Procalcitonin; Protein Precursors; Renal Insufficiency; Respiratory Insufficiency; ROC Curve; Sepsis; Shock, Septic

The inflammatory biomarker pro-adrenomedullin (ProADM) provides additional prognostic information for the risk stratification of general medical emergency department (ED) patients. The aim of this analysis was to develop a triage algorithm for improved prognostication and later use in an interventional trial.. We used data from the multi-national, prospective, observational TRIAGE trial including consecutive medical ED patients from Switzerland, France and the United States. We investigated triage effects when adding ProADM at two established cut-offs to a five-level ED triage score with respect to adverse clinical outcome.. Mortality in the 6586 ED patients showed a step-wise, 25-fold increase from 0.6% to 4.5% and 15.4%, respectively, at the two ProADM cut-offs (≤0.75nmol/L, >0.75-1.5nmol/L, >1.5nmol/L, p ANOVA <0.0001). Risk stratification by combining ProADM within cut-off groups and the triage score resulted in the identification of 1662 patients (25.2% of the population) at a very low risk of mortality (0.3%, n = 5) and 425 patients (6.5% of the population) at very high risk of mortality (19.3%, n = 82). Risk estimation by using ProADM and the triage score from a logistic regression model allowed for a more accurate risk estimation in the whole population with a classification of 3255 patients (49.4% of the population) in the low risk group (0.3% mortality, n = 9) and 1673 (25.4% of the population) in the high-risk group (15.1% mortality, n = 252).. Within this large international multicenter study, a combined triage score based on ProADM and established triage scores allowed a more accurate mortality risk discrimination. The TRIAGE-ProADM score improved identification of both patients at the highest risk of mortality who may benefit from early therapeutic interventions (rule in), and low risk patients where deferred treatment without negatively affecting outcome may be possible (rule out).

Topics: Adrenomedullin; Aged; Aged, 80 and over; Biomarkers; Cardiovascular Diseases; Emergency Service, Hospital; Female; Gastrointestinal Diseases; Humans; Infections; International Agencies; Male; Middle Aged; Nervous System Diseases; Prognosis; Prospective Studies; Risk Assessment; Severity of Illness Index; Triage

Adrenomedullin (AM) is secreted into the cerebrospinal fluid (CSF) from the choroid plexus and regulates appetite. Adrenomedullin concentration in the CSF is elevated 7-10 days after the onset of aneurysmal subarachnoid hemorrhage (SAH). The aim of the present study was to determine whether CSF AM concentration is related to appetite and delayed ischemic neurological deficits (DIND) after SAH.. Adrenomedullin concentration in the CSF, blood plasma profile, and appetite status were measured in 22 patients with SAH who underwent aneurysmal clipping within 48 hours of SAH onset. Appetite status was measured using dietary oral calorie intake and self-reported appetite level. All outcome variables were measured at an early (Day 3) and late (Day 8) time point after SAH onset (Day 0).. Dietary oral calorie intake (P = 0·02), self-reported appetite level (P = 0·03), hemoglobin (P = 0·01), albumin (P = 0·03), glucose (P = 0·01), and insulin (P = 0·03) levels were lower at the late time point than at the early time point. Cerebrospinal fluid adrenomedullin concentration was higher at the late time point than at the early time point (P = 0·0007). There was a significant negative correlation between AM concentration and dietary oral calorie intake (r = -0·478, P = 0·024) and self-reported appetite level (r = -0·454, P = 0·033) at the late time point. Six patients (27%) developed DIND. Adrenomedullin concentration at the late time point was significantly higher in patients who developed DIND than in patients who did not (P = 0·02).. Cerebrospinal fluid adrenomedullin concentration 8 days after SAH onset is related to appetite loss and DIND.

Topics: Adrenomedullin; Appetite; Female; Humans; Male; Middle Aged; Nervous System Diseases; Subarachnoid Hemorrhage

The presence of adrenomedullin-like immunoreactivity in the cerebrospinal fluid was studied by radioimmunoassay in 13 subjects with various neurological diseases. The concentrations of adrenomedullin-like immunoreactivity in the cerebrospinal fluid were 9.4 +/- 3.1 pmol/l (mean +/- SD, n = 13). Reverse-phase high performance liquid chromatography of the extract of the pooled cerebrospinal fluid showed that approximately 40% of the adrenomedullin-like immunoreactivity was chromatographically identical to human adrenomedullin (1-52). This is the first report that demonstrates the presence of adrenomedullin-like immunoreactivity in the human cerebrospinal fluid.

Topics: Adrenomedullin; Adult; Aged; Chromatography, Gel; Female; Humans; Male; Middle Aged; Nervous System Diseases; Peptides; Radioimmunoassay; Vasodilator Agents