Time course of proadrenomedullin in the early phase of septic shock. A comparative study with other proinflammatory proteins.
OBJECTIVE
It has been shown that pro-adrenomedullin is a good marker of the severity of septic shock but there are no data on the early changes in serum pro-adrenomedullin concentrations in patients with shock.


METHODS
Twenty-one patients with septic shock and 21 healthy subjects studied as controls. Serum concentrations of pro-adrenomedullin, procalcitonin, ferritin, CRP and IL-6 were determined in all subjects at the initial observation. Patients with septic shock were also studied after 24 and 48 hours.


RESULTS
The concentrations of the acute phase proteins were significantly higher in patients with septic shock than in the control subjects during the entire study period (P<0.001). Only procalcitonin significantly decreased on the third day of observation with respect to both the first day (P=0.002) and the second day (P=0.006). Proadrenomedullin (P=0.017) and IL-6 (P=0.001) showed an AUC significantly different from the null hypothesis in differentiating the patients who survived and those who did not. The sensitivity and specificity of pro-adrenomedullin in the assessment of death were 71.4% and 72.7%, respectively, while IL-6 had a sensitivity of 92.9% and a specificity of 60.6%.


CONCLUSIONS
Proadrenomedullin is a reliable prognostic marker in patients with shock; further studies on a more consistent number of septic patients will definitively assess whether proadrenomedullin may replace the current prognostic markers in critically ill patients with shock due to sepsis.
Department of Digestive Diseases and Internal Medicine, Sant'Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy. raffaele.pezzilli@aosp.bo.it
R
R
Pezzilli
A
A
Barassi
A
A
Pigna
A M
AM
Morselli-Labate
A
A
Imbrogno
D
D
Fabbri
G
G
Di Nino
R
R
Corinaldesi
G
G
Melzi D'Eril
D000209:Acute-Phase Proteins / Q000378:metabolism; D053607:Adrenomedullin / Q000096:biosynthesis* / Q000097:blood; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D002097:C-Reactive Protein / Q000096:biosynthesis; D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D005260:Female; D005293:Ferritins / Q000097:blood; D006801:Humans; D007249:Inflammation; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011498:Protein Precursors / Q000096:biosynthesis* / Q000097:blood; D012680:Sensitivity and Specificity; D012772:Shock, Septic / Q000378:metabolism*; D013997:Time Factors
D000209:Acute-Phase Proteins; C000606589:CALCA protein, human; D015850:Interleukin-6; D011498:Protein Precursors; C088633:proadrenomedullin; D053607:Adrenomedullin; D002116:Calcitonin; D002097:C-Reactive Protein; D005293:Ferritins; D015740:Calcitonin Gene-Related Peptide