title: The predictive value of adrenomedullin for development of severe sepsis and septic shock in emergency department.
abstract: OBJECTIVE
  The aim of the study was to assess adrenomedullin (AM) as a predictor for development of severe sepsis and septic shock in emergency department (ED).
  
  
  METHODS
  From December 2011 to October 2012, 372 consecutive septic patients admitted to ED were enrolled. AM was examined in every patient. All patients were followed up for 3 days. The outcome variable was development of severe sepsis or septic shock. The predictive ability of AM was evaluated by binary logistic regression analysis and receiver operating characteristic (ROC) curve.
  
  
  RESULTS
  On admission, the differences of AM among patients with different comorbidities, infections, and culture results were not significant. AM level was higher in patients who progressed than in who did not (41.63 ± 6.55 versus 31.31 ± 7.71 ng/L, P < 0.001). AM was the only independent predictor of outcome. The area under ROC curve of AM was 0.847. With a cutoff value of 41.24 ng/L, the sensitivity was 67.6%, the specificity was 90.0%, the positive predictive value was 61.5%, the negative predictive value was 92.2%, the positive likelihood ratio was 6.78, and the negative likelihood ratio was 0.36.
  
  
  CONCLUSIONS
  Adrenomedullin is valuable for predicting development of severe sepsis and septic shock in ED.
authors.affiliation: Emergency Department of Beijing Chao-Yang Hospital, Affiliated to Capital Medical University, Chaoyang District, Beijing 100020, China. candychen108@163.com
authors.forename: Yun-Xia
authors.initials: YX
authors.lastname: Chen
authors.forename: Chun-Sheng
authors.initials: CS
authors.lastname: Li
mesh_terms: D053607:Adrenomedullin / Q000097:blood*; D000368:Aged; D002681:China / Q000453:epidemiology; D015897:Comorbidity; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D012772:Shock, Septic / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D053607:Adrenomedullin