title: Primary Graft Dysfunction and Mortality Following Lung Transplantation: A Role for Proadrenomedullin Plasma Levels.
abstract: Primary graft dysfunction (PGD) after lung transplantation (LT) is a heterogeneous syndrome that comprises clinical presentations with diverse grades of severity. Proadrenomedullin (proADM) levels may be associated with PGD and may enhance its relationship with outcomes. We prospectively included 100 LT recipients. Plasma levels of proADM were measured at 24, 48 and 72 h after admission to the intensive care unit (ICU). We assessed their relationship with PGD grade and ICU mortality. Fifty patients (50%) presented grade 3 PGD at ICU admission. Twenty-two patients (22%) developed grade 3 PGD at 72 h, the only grade associated with higher mortality (odds ratio 6.84, 95% confidence interval [CI] 1.47-38.44). ProADM levels measured at 24 h (3.25 vs. 1.61 nmol/L; p = 0.016) and 72 h (2.17 vs. 1.35 nmol/L; p = 0.011) were higher in these patients than the rest of the population. When we added the individual predictive utility of grade 3 PGD at 72 h for ICU mortality (area under the curve [AUC] 0.72, 95% CI 0.53-0.90) to that of ProADM at 72 h, the predictive value of the model improved (AUC 0.81, 95% CI 0.65-0.97). Higher levels of proADM measured following LT are associated with grade 3 PGD at 72 h. ProADM enhances the association of this entity with mortality.
authors.affiliation: Critical Care Department, Vall d'Hebron University Hospital, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.|Vall d'Hebron Research Institut, Barcelona, Spain.|CIBERES, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Riera
authors.affiliation: Vall d'Hebron Research Institut, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Senna
authors.affiliation: Vall d'Hebron Research Institut, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Cubero
authors.affiliation: Vall d'Hebron Research Institut, Barcelona, Spain.|CIBERES, Instituto de Salud Carlos III, Madrid, Spain.|Department of Pulmonology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Roman
authors.affiliation: Critical Care Department, Vall d'Hebron University Hospital, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.|Vall d'Hebron Research Institut, Barcelona, Spain.|CIBERES, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Rello
mesh_terms: D053607:Adrenomedullin / Q000097:blood*; D000328:Adult; D015415:Biomarkers / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000401:mortality*; D006085:Graft Survival; D006801:Humans; D007362:Intensive Care Units; D008171:Lung Diseases / Q000601:surgery*; D016040:Lung Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D055031:Primary Graft Dysfunction / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000401:mortality*; D011379:Prognosis; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D011498:Protein Precursors; C088633:proadrenomedullin; D053607:Adrenomedullin