Midregional proadrenomedullin (MR-proADM) in the risk stratification of patients with acute pulmonary embolism.
BACKGROUND
According to current ESC guidelines not only hemodynamic parameters, but also indices of right ventricular dysfunction such as NT-proBNP have a significant prognostic value in acute pulmonary embolism (PE). MR-proADM is a significant predictor of short-term mortality in acute heart failure and adds prognostic value to NT-proBNP. We hypothesized that plasma MR-proADM is elevated in acute PE, correlates with the severity of PE and has prognostic value. We also compared prognostic values of MR-proADM and NT-proBNP for the prediction of early mortality in acute PE.


METHODS
We studied 98 patients (51F/47M, 59.6 ± 18.4 yr) with acute PE. On admission blood samples were collected for MR-proADM and NT-proBNP.


RESULTS
MR-proADM reflected the severity of acute PE: 0.734 nmol/L in low-risk acute PE (0.384-1.342), 0.995 nmol/L in intermediate-risk acute PE (0.394-7.499) and 2.062 nmol/L in high-risk acute PE (0.447-3.098), p<0.001. MR-proADM was higher in non-survivors than in survivors 2.123 nmol/L (1.543-4.220), vs. 0.910 nmol/L (0.384-7.449), p=0.0003. The AUC of MR-proADM and NT-proBNP ROC curves for predicting all-cause mortality were 0.935 (95% CI 0.861-0.977) and 0.844 (95% CI 0.749-0. 913), respectively. In univariable analysis NT-proBNP and MR-proADM were significant predictors of all-cause mortality HR 1.00 (95% CI 1.000-1.0002, p=0.029) and 1.65 (95% CI 1.214 - 2.249, p=0.015). However, in multivariate analysis, MR-proADM but not NT-proBNP was a significant predictor of all-cause mortality.


CONCLUSIONS
NT-proBNP and MR-proADM are of similar predictive value in the assessment of outcome in acute PE, however MR-proADM seems to be superior in predicting all-cause mortality.
Department of Cardiovascular and Pulmonary Thromboembolic Diseases CMKP, European Health Centre Otwock, F. Chopin Hospital, Borowa 14/18, 05-400, Otwock, Poland. Electronic address: jpedowska@tlen.pl.
Justyna
J
Pedowska-Włoszek
Maciej
M
Kostrubiec
Katarzyna
K
Kurnicka
Michal
M
Ciurzynski
Piotr
P
Palczewski
Piotr
P
Pruszczyk
D000208:Acute Disease; D053607:Adrenomedullin / Q000097:blood*; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011379:Prognosis; D011498:Protein Precursors / Q000097:blood*; D011655:Pulmonary Embolism / Q000097:blood* / Q000175:diagnosis*; D018570:Risk Assessment
D010446:Peptide Fragments; D011498:Protein Precursors; C109794:pro-brain natriuretic peptide (1-76); C088633:proadrenomedullin; D020097:Natriuretic Peptide, Brain; D053607:Adrenomedullin
NTproBNP; acute pulmonary embolism; proadrenomedullin; prognosis