title: Elevated asymmetric dimethylarginine levels predict short- and long-term mortality risk in critically ill patients.
abstract: OBJECTIVE
  Serum concentrations of asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthase, may contribute to endothelial dysfunction and organ failure in sepsis. We aimed at investigating ADMA levels as a potential diagnostic or prognostic biomarker in critically ill patients.
  
  
  METHODS
  Two hundred fifty-five patients (164 with sepsis, 91 without sepsis) were studied prospectively upon admission to the medical intensive care unit (ICU) and on day 7, in comparison to 78 healthy controls. ADMA serum concentrations were correlated with clinical data and extensive laboratory parameters. Patients' survival was followed up for up to 3 years.
  
  
  RESULTS
  ADMA serum levels were significantly elevated in critically ill patients at admission compared to controls. ADMA levels did not differ between patients with or without sepsis, but were closely related to hepatic and renal dysfunction, metabolism and clinical scores of disease severity. ADMA levels further increased during the first week of ICU treatment. ADMA serum levels at admission were an independent prognostic biomarker in critically ill patients not only for short-term mortality at the ICU, but also for unfavorable long-term survival.
  
  
  CONCLUSIONS
  Serum ADMA concentrations are significantly elevated in critically ill patients, associated with organ failure and related to short- and long-term mortality risk.
authors: Department of Medicine III, RWTH-University Hospital Aachen, Pauwelsstrasse 30, Aachen, Germany.
authors: Alexander
authors: A
authors: Koch
authors: Ralf
authors: R
authors: Weiskirchen
authors: Julian
authors: J
authors: Kunze
authors: Hanna
authors: H
authors: Dückers
authors: Jan
authors: J
authors: Bruensing
authors: Lukas
authors: L
authors: Buendgens
authors: Michael
authors: M
authors: Matthes
authors: Tom
authors: T
authors: Luedde
authors: Christian
authors: C
authors: Trautwein
authors: Frank
authors: F
authors: Tacke
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001120:Arginine / Q000031:analogs & derivatives* / Q000097:blood; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D016638:Critical Illness / Q000401:mortality*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000097:blood / Q000401:mortality; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000097:blood / Q000401:mortality; D012720:Severity of Illness Index; D015996:Survival Rate
chemical_list: D015415:Biomarkers; C018524:N,N-dimethylarginine; D001120:Arginine
keywords: ADMA; ICU; Organ failure; Prognosis; Sepsis