title: Plasma midregional pro-adrenomedullin improves prediction of functional outcome in ischemic stroke.
abstract: BACKGROUND
  To evaluate if plasma levels of midregional pro-adrenomedullin (MR-proADM) improve prediction of functional outcome in ischemic stroke.
  
  
  METHODS
  In 168 consecutive ischemic stroke patients, plasma levels of MR-proADM were measured within 24 hours from symptom onset. Functional outcome was assessed by the modified Rankin Scale (mRS) at 90 days following stroke. Logistic regression, receiver operating characteristics (ROC) curve analysis, net reclassification improvement (NRI), and Kaplan-Meier survival analysis were applied.
  
  
  RESULTS
  Plasma MR-proADM levels were found significantly higher in patients with unfavourable (mRS 3-6) compared to favourable (mRS 0-2) outcomes. MR-proADM levels were entered into a predictive model including the patients' age, National Institutes of Health Stroke Scale (NIHSS), and the use of recanalization therapy. The area under the ROC curve did not increase significantly. However, category-free NRI of 0.577 (p<0.001) indicated a significant improvement in reclassification of patients. Furthermore, MR-proADM levels significantly improved reclassification of patients in the prediction of outcome by the Stroke Prognostication using Age and NIHSS-100 (SPAN-100; NRI = 0.175; p = 0.04). Kaplan-Meier survival analysis showed a rising risk of death with increasing MR-proADM quintiles.
  
  
  CONCLUSIONS
  Plasma MR-proADM levels improve prediction of functional outcome in ischemic stroke when added to the patients' age, NIHSS on admission, and the use of recanalization therapy. Levels of MR-proADM in peripheral blood improve reclassification of patients when the SPAN-100 is used to predict the patients' functional outcome.
authors.affiliation: Department of Neurology, Medical University of Graz, Graz, Austria. thomas.seifert@medunigraz.at
authors.forename: Thomas
authors.initials: T
authors.lastname: Seifert-Held
authors.forename: Thomas
authors.initials: T
authors.lastname: Pekar
authors.forename: Thomas
authors.initials: T
authors.lastname: Gattringer
authors.forename: Nicole E
authors.initials: NE
authors.lastname: Simmet
authors.forename: Hubert
authors.initials: H
authors.lastname: Scharnagl
authors.forename: Christoph
authors.initials: C
authors.lastname: Bocksrucker
authors.forename: Christian
authors.initials: C
authors.lastname: Lampl
authors.forename: Maria K
authors.initials: MK
authors.lastname: Storch
authors.forename: Tatjana
authors.initials: T
authors.lastname: Stojakovic
authors.forename: Franz
authors.initials: F
authors.lastname: Fazekas
mesh_terms: D000293:Adolescent; D053607:Adrenomedullin / Q000097:blood*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011498:Protein Precursors / Q000097:blood*; D020521:Stroke / Q000097:blood* / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D055815:Young Adult
chemical_list: D011498:Protein Precursors; C088633:proadrenomedullin; D053607:Adrenomedullin
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