Persistent high level of circulating midregional-proadrenomedullin and increased risk of nosocomial infections after septic shock.
BACKGROUND
Risk stratification could represent a major improvement in critically ill patients' management. The objective of this study is to evaluate the association between concentrations of four circulating prohormones (C-terminal-provasopressin, midregional-proadrenomedullin (MR-proADM), midregional-proatrial natriuretic peptide, and C-terminal- proendothelin-1) and the occurrence of nosocomial infections (NIs) in septic shock patients.


METHODS
We performed an observational, clinical study with septic shock patients (n = 98) recruited from adult intensive care units in a university hospital. Prohormone concentrations were assessed three times within the first week after the onset of septic shock using an immunoluminometric assay.


RESULTS
Significantly elevated plasmatic MR-proADM concentrations were measured in patients who went on to develop NIs in comparison with patients who remain infection free (p = 0.043). No differences were observed for the other three prohormone concentrations.


CONCLUSIONS
Elevated plasmatic MR-proADM concentration is associated with the development of secondary NIs after septic shock. This information, if confirmed in a larger group of patients, could represent a major advance in the monitoring of intensive care unit patient infectious risk.
Immunology Laboratory, E. Herriot Hospital, Hospices Civils de Lyon, France.
Caroline
C
Guignant
Nicolas
N
Voirin
Fabienne
F
Venet
Alain
A
Lepape
Guillaume
G
Monneret
D053607:Adrenomedullin / Q000097:blood*; D000368:Aged; D009320:Atrial Natriuretic Factor / Q000097:blood; D015331:Cohort Studies; D003428:Cross Infection / Q000097:blood / Q000209:etiology*; D019332:Endothelin-1 / Q000097:blood; D005260:Female; D006020:Glycopeptides / Q000097:blood; D006801:Humans; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000097:blood; D011498:Protein Precursors / Q000097:blood*; D012307:Risk Factors; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000097:blood / Q000150:complications*
C557077:C-terminal proendothelin-1; D019332:Endothelin-1; D006020:Glycopeptides; D010446:Peptide Fragments; D011498:Protein Precursors; C048197:copeptins; C552580:midregional pro-atrial natriuretic peptide, human; C088633:proadrenomedullin; D053607:Adrenomedullin; D009320:Atrial Natriuretic Factor