title: Midregion prohormone adrenomedullin and prognosis in patients presenting with acute dyspnea: results from the BACH (Biomarkers in Acute Heart Failure) trial.
abstract: OBJECTIVE
  The aim of this study was to determine the prognostic utility of midregion proadrenomedullin (MR-proADM) in all patients, cardiac and noncardiac, presenting with acute shortness of breath.
  
  
  BACKGROUND
  The recently published BACH (Biomarkers in Acute Heart Failure) study demonstrated that MR-proADM had superior accuracy for predicting 90-day mortality compared with B-type natriuretic peptide (area under the curve: 0.674 vs. 0.606, respectively, p < 0.001) in acute heart failure.
  
  
  METHODS
  The BACH trial was a prospective, 15-center, international study of 1,641 patients presenting to the emergency department with dyspnea. Using this dataset, the prognostic accuracy of MR-proADM was evaluated in all patients enrolled for predicting 90-day mortality with respect to other biomarkers, the added value in addition to clinical variables, as well as the added value of additional measurements during hospital admission.
  
  
  RESULTS
  Compared with B-type natriuretic peptide or troponin, MR-proADM was superior for predicting 90-day all-cause mortality in patients presenting with acute dyspnea (c index = 0.755, p < 0.0001). Furthermore, MR-proADM added significantly to all clinical variables (all adjusted hazard ratios: >3.28), and it was also superior to all other biomarkers. MR-proADM added significantly to the best clinical model (bootstrap-corrected c index increase: 0.775 to 0.807; adjusted standardized hazard ratio: 2.59; 95% confidence interval: 1.91 to 3.50; p < 0.0001). Within the model, MR-proADM was the biggest contributor to the predictive performance, with a net reclassification improvement of 8.9%. Serial evaluation of MR-proADM performed in patients admitted provided a significant added value compared with a model with admission values only (p = 0.0005). More than one-third of patients originally at high risk could be identified by the biomarker evaluation at discharge as low-risk patients.
  
  
  CONCLUSIONS
  MR-proADM identifies patients with high 90-day mortality and adds prognostic value to natriuretic peptides in patients presenting with acute shortness of breath. Serial measurement of this biomarker may also prove useful for monitoring, although further studies will be required. (Biomarkers in Acute Heart Failure [BACH]; NCT00537628).
authors.affiliation: VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, USA. amaisel@ucsd.edu
authors.forename: Alan
authors.initials: A
authors.lastname: Maisel
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
authors.forename: Richard M
authors.initials: RM
authors.lastname: Nowak
authors.forename: W Frank
authors.initials: WF
authors.lastname: Peacock
authors.forename: Piotr
authors.initials: P
authors.lastname: Ponikowski
authors.forename: Martin
authors.initials: M
authors.lastname: Mockel
authors.forename: Christopher
authors.initials: C
authors.lastname: Hogan
authors.forename: Alan H B
authors.initials: AH
authors.lastname: Wu
authors.forename: Mark
authors.initials: M
authors.lastname: Richards
authors.forename: Paul
authors.initials: P
authors.lastname: Clopton
authors.forename: Gerasimos S
authors.initials: GS
authors.lastname: Filippatos
authors.forename: Salvatore
authors.initials: S
authors.lastname: Di Somma
authors.forename: Inder
authors.initials: I
authors.lastname: Anand
authors.forename: Leong L
authors.initials: LL
authors.lastname: Ng
authors.forename: Lori B
authors.initials: LB
authors.lastname: Daniels
authors.forename: Sean-Xavier
authors.initials: SX
authors.lastname: Neath
authors.forename: Robert
authors.initials: R
authors.lastname: Christenson
authors.forename: Mihael
authors.initials: M
authors.lastname: Potocki
authors.forename: James
authors.initials: J
authors.lastname: McCord
authors.forename: Oliver
authors.initials: O
authors.lastname: Hartmann
authors.forename: Nils G
authors.initials: NG
authors.lastname: Morgenthaler
authors.forename: Stefan D
authors.initials: SD
authors.lastname: Anker
mesh_terms: D053607:Adrenomedullin / Q000097:blood*; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D004417:Dyspnea / Q000097:blood* / Q000175:diagnosis / Q000401:mortality*; D006333:Heart Failure / Q000401:mortality; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*
chemical_list: D015415:Biomarkers; D011498:Protein Precursors; C088633:proadrenomedullin; D053607:Adrenomedullin