title: Plasma bioactive adrenomedullin as a prognostic biomarker in acute heart failure.
abstract: OBJECTIVE
  The objective was to evaluate the prognostic performance of a new biomarker, plasma bioactive adrenomedullin (bio-ADM), for short-term clinical outcomes in acute heart failure.
  
  
  METHODS
  A multicenter prospective cohort study of adult emergency department (ED) patients suspected of having acute heart failure was conducted to evaluate the association between plasma bio-ADM concentration and clinical outcomes. The primary outcome was a composite of the following within 30 days: death, cardiac arrest with resuscitation, respiratory failure, emergency dialysis, acute coronary syndrome, hospitalization >5 days, and repeat ED visit or hospitalization. Prognostic accuracy was evaluated with a nonparametric receiver operating characteristic curve. In addition, a multivariable logistic regression model was constructed to assess the additive prognostic performance of bio-ADM while adjusting for other biomarkers routinely used clinically, including B-type natriuretic peptide, cardiac troponin I, creatinine, and sodium concentration.
  
  
  RESULTS
  Two hundred forty-six patients were enrolled, including 85 (34.6%) patients with the primary outcome. Plasma bio-ADM concentrations were higher among patients who experienced the primary outcome (median, 80.5 pg/mL; interquartile range [IQR], 53.7-151.5 pg/mL) compared with those who did not (median, 54.4 pg/mL; IQR, 43.4-78.4 pg/mL) (P < .01). Area under the receiver operating characteristic curve was 0.70 (95% confidence interval, 0.63-0.75). After adjusting for the other biomarkers, plasma bio-ADM remained a strong predictor of the primary outcome (adjusted odds ratio per IQR change, 2.68; 95% confidence interval, 1.60-4.51).
  
  
  CONCLUSIONS
  Bioactive adrenomedullin concentrations at the time of ED evaluation for acute heart failure were predictive of clinically important 30-day outcomes, suggesting that bio-ADM is a promising prognostic marker for further study.
authors.affiliation: Department of Emergency Medicine, Vanderbilt University, Nashville, TN, USA. Electronic address: wesley.self@vanderbilt.edu.
authors.forename: Wesley H
authors.initials: WH
authors.lastname: Self
authors.affiliation: Department of Emergency Medicine, Vanderbilt University, Nashville, TN, USA.
authors.forename: Alan B
authors.initials: AB
authors.lastname: Storrow
authors.affiliation: Sphingotec, GmbH, Hennigsdorf, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Hartmann
authors.affiliation: Department of Emergency Medicine, Vanderbilt University, Nashville, TN, USA.
authors.forename: Tyler W
authors.initials: TW
authors.lastname: Barrett
authors.affiliation: Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, USA.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Fermann
authors.affiliation: Coronary Care Unit and Heart Failure Program, San Diego Veterans Affairs Medical Center, San Diego, CA, USA.
authors.forename: Alan S
authors.initials: AS
authors.lastname: Maisel
authors.affiliation: Sphingotec, GmbH, Hennigsdorf, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Struck
authors.affiliation: Sphingotec, GmbH, Hennigsdorf, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Bergmann
authors.affiliation: Department of Emergency Medicine, Vanderbilt University, Nashville, TN, USA.
authors.forename: Sean P
authors.initials: SP
authors.lastname: Collins
mesh_terms: D053607:Adrenomedullin / Q000097:blood*; D000368:Aged; D015415:Biomarkers / Q000097:blood; D004636:Emergency Service, Hospital; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000401:mortality / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies
chemical_list: D015415:Biomarkers; D053607:Adrenomedullin