title: Postoperative pro-adrenomedullin levels predict mortality in thoracic surgery patients: comparison with Acute Physiology and Chronic Health Evaluation IV Score*.
abstract: OBJECTIVE
  Risk assessment in ICU patients using commonly used prognostic models may be influenced using different data definitions and by errors in data collection. We investigated whether a set of biomarkers (procalcitonin, MR-pro-adrenomedullin, CT-pro-endothelin-1, CT-pro-arginine vasopressin, and MR-pro-atrial natriuretic peptide), alone or as a panel, could be useful in postoperative risk assessment for hospital mortality in comparison with the Acute Physiology and Chronic Health Evaluation IV score.
  
  
  METHODS
  In a prospective observational cohort study, we analyzed 800 consecutive patients undergoing elective cardiac surgery. We assessed biomarker levels on admission to the ICU and every 6 hours thereafter for 24 hours. For every postoperative time point and for every biomarker, we determined the predictive value for hospital mortality and made a comparison with the Acute Physiology and Chronic Health Evaluation IV score.
  
  
  METHODS
  Intensive care of an academic referral hospital.
  
  
  METHODS
  A total of 800 consecutive patients undergoing elective cardiac surgery.
  
  
  METHODS
  None.
  
  
  RESULTS
  MR-pro-adrenomedullin is a good predictor of mortality (c-statistic at time point 6 hr after admission to the ICU, 0.940; 95% CI, 0.918-0.956) and performed better than the Acute Physiology and Chronic Health Evaluation IV score (c-statistic, 0.842; 95% CI, 0.811-0.868). The c-statistic did not change significantly on the time points 6, 12, and 18 hours after admission. Using a cutoff value for proadrenomedullin taken 6 hours after admission on ICU (time point 2) of 3.2 nmol/L sensitivity was 81.8% and specificity 93.9%, the positive likelihood ratio was 13.3, positive predictive value was 31.0%, and negative predictive value was 99.4%. Patients with a MR-pro-adrenomedullin above this cutoff level had an odds ratio of 68.9 (95% CI, 22.2-213.1) for not surviving their hospital stay. The other biomarkers had less predictive power.
  
  
  CONCLUSIONS
  In elective cardiac surgery, MR-pro-adrenomedullin measured between 6 and 18 hours after admission to the ICU is a better predictor of hospital mortality in comparison with the Acute Physiology and Chronic Health Evaluation IV score.
authors.affiliation: 1Department of Intensive Care, Leiden University Medical Center, Leiden, The Netherlands. 2Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands. 3Thermo Fisher Scientific/B.R.A.H.M.S. GmbH, Hennigsdorf, Germany. 4Department of Thoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Abraham
authors.initials: A
authors.lastname: Schoe
authors.forename: Emile F
authors.initials: EF
authors.lastname: Schippers
authors.forename: Joachim
authors.initials: J
authors.lastname: Struck
authors.forename: Stefan
authors.initials: S
authors.lastname: Ebmeyer
authors.forename: Robert J M
authors.initials: RJ
authors.lastname: Klautz
authors.forename: Evert
authors.initials: E
authors.lastname: de Jonge
authors.forename: Jaap T
authors.initials: JT
authors.lastname: van Dissel
mesh_terms: D018806:APACHE; D000046:Academic Medical Centers; D053607:Adrenomedullin / Q000097:blood*; D000368:Aged; D015415:Biomarkers; D006348:Cardiac Surgical Procedures / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011379:Prognosis; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D018570:Risk Assessment; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D011498:Protein Precursors; C088633:proadrenomedullin; D053607:Adrenomedullin