Prognostic Value of Bioactive Adrenomedullin in Critically Ill Patients

This study's objective is to assess the prognostic value of the serum level of admission bio-ADM in critically ill patients. In this observational prospective study, patients who were admitted to Minia University Hospitals' medical critical care unit between December 2020 and November 2021 underwent a complete blood count, CRP , renal and liver function tests and blood culture. All patients had their bio-adrenomedullin levels evaluated by ELISA at the time of admission. The work included 114 patients who were subdivided into 3 groups: non-septic group including SIRS patients with negative blood culture (n=44), mild sepsis group including patients with SOFA score ≥2 without organ dysfunction (n=26), and severe sepsis group including sepsis patients with organ dysfunction (n=44). There was a significant difference in distribution of the quartiles of bio-ADM between survivor and non-survivors. Most of the non-survivors in our cohort were in the 4th quartile of bio-ADM (38.9%) while 45% of the survivors were in the 1st quartile of bio-ADM. The levels of Bio-ADM were positively correlated with CRP (r-value: 0.65, p-value < 0.001) and SOFA score (r-value: 0.63, p-value < 0.001). Using receiver operating characteristic (ROC) curve to determine the prognostic accuracy of bio-ADM, CRP, and SOFA score revealed higher area under curve (AUC) for bio-ADM (0.78, 95% CI: 0.69-0.86) followed by CRP (0.66, 95% CI: 0.56-0.76) and SOFA score (0.63, 95% CI: 0.52-0.73). The best cut-off for bio-ADM to predict ICU mortality in our cohort was 121.5 pg/ml with a sensitivity of 85% and a specificity of 61%.