MR‐ proADM to detect specific types of organ failure in infection

• Published in: European journal of clinical investigation Vol. 50; no. 6; pp. e13246 - n/a
• Main Authors: Andrés, Cristina, Andaluz‐Ojeda, David, Cicuendez, Ramón, Nogales, Leonor, Martín, Silvia, Martin‐Fernandez, Marta, Almansa, Raquel, Calvo, Dolores, Esteban‐Velasco, Maria Carmen, Vaquero‐Roncero, Luis Mario, Ríos‐Llorente, Alberto, Sanchez‐Barrado, Elisa, Muñoz‐Bellvís, Luis, Aldecoa, César, Bermejo‐Martin, Jesus F.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.06.2020
• Subjects: Adrenomedullin; Adrenomedullin - blood; Aged; Aged, 80 and over; Area Under Curve; Biomarkers; Blood Coagulation Disorders - blood; Blood Coagulation Disorders - diagnosis; C-Reactive Protein - metabolism; Cardiovascular Diseases - blood; Cardiovascular Diseases - diagnosis; Coagulation; Failure; Female; Heart Failure - blood; Heart Failure - diagnosis; Humans; infection; Infections; Infections - blood; Intensive Care Units; Kidneys; Lactic acid; Lactic Acid - blood; Liver; Liver Failure - blood; Liver Failure - diagnosis; Male; Mathematical analysis; Middle Aged; Multivariate Analysis; Nervous System Diseases - blood; Nervous System Diseases - diagnosis; Organ Dysfunction Scores; organ failure; Peptide Fragments - blood; Procalcitonin; Procalcitonin - blood; Protein Precursors - blood; Regression analysis; Renal failure; Renal Insufficiency - blood; Renal Insufficiency - diagnosis; Respiratory Insufficiency - blood; Respiratory Insufficiency - diagnosis; ROC Curve; Sepsis; Sepsis - blood; Sepsis - diagnosis; Septic shock; Shock, Septic - blood; Shock, Septic - diagnosis; infection; biomarkers; sepsis; organ failure
• ISSN: 0014-2972; 1365-2362
• DOI: 10.1111/eci.13246

Background 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. Materials and methods 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). Results 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. Conclusions In patients with infection, MR‐proADM was the biomarker detecting the largest number of SOFA score components, with the exception of hepatic failure.