Mid-regional pro-adrenomedullin (MR-proADM), a marker of positive fluid balance in critically ill patients: results of the ENVOL study.
The optimal control of blood volume without fluid overload is a main challenge in the daily care of intensive care unit (ICU) patients. Accordingly this study focused on the identification of biomarkers to help characterize fluid overload status.



Sixty-seven patients were studied from ICU admission to day 7 (D7). Blood and urine samples were taken daily and sodium and water balance strictly calculated resulting in a total cumulative assessment of ∆Na+and ∆H2O. Furthermore, plasmatic biomarkers (cortisol, epinephrine, norepinephrine, renin, angiotensin II, aldosterone, pro-endothelin, copeptine, atrial natriuretic peptide, erythropoietin, mid-regional pro-adrenomedullin (MR-proADM)) and Sequential Organ Failure Assessment (SOFA) scores were measured at D2, D5and D7. Blood volumes were measured with51Cr fixed on red blood cells at D2and D7.



The ∆Na+or ∆H2O were increased in all patients but never related to blood volumes at D2nor D7. Total blood volumes were at normal values with constantly low red blood cell volumes and normal or decreased plasmatic volume. Weight, plasmatic proteins, and hemoglobin were weakly related to ∆Na+or ∆H2O. Amongst all tested biomarkers, only MR-proADM was related to sodium and fluid overload. This biomarker was also a predictor of SOFA scores.



Plasmatic concentration in MR-proADM seems to be a good surrogate for evaluation of ∆Na+or ∆H2O and predicts sodium and extracellular fluid overload.



ClinicalTrials.gov: NCT01858675 in May 13, 2013.
Département d'Anesthésie-Réanimation, Hôpital de Bicêtre, Université Paris-Sud, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, Paris, France. bernard.vigue@bct.aphp.fr.
Bernard
B
Vigué
Département d'Anesthésie-Réanimation, Hôpital de Bicêtre, Université Paris-Sud, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, Paris, France.
Pierre-Etienne
PE
Leblanc
Service de biophysique et de médecine nucléaire, Centre Hospitalier Universitaire de Bicêtre, Assistance publique - Hôpitaux de Paris, Paris, France.
Frédérique
F
Moati
Service de Génétique Moléculaire, Pharmacogénétique et Hormonologie, Inserm U1185, Centre Hospitalier Universitaire de Bicêtre, Assistance publique - Hôpitaux de Paris, Paris, France.
Eric
E
Pussard
Département d'Anesthésie-Réanimation, Hôpital de Bicêtre, Université Paris-Sud, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, Paris, France.
Hussam
H
Foufa
Département d'Anesthésie-Réanimation, Hôpital de Bicêtre, Université Paris-Sud, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, Paris, France.
Aurore
A
Rodrigues
Département d'Anesthésie-Réanimation, Hôpital de Bicêtre, Université Paris-Sud, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, Paris, France.
Samy
S
Figueiredo
Département d'Anesthésie-Réanimation, Hôpital de Bicêtre, Université Paris-Sud, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, Paris, France.
Anatole
A
Harrois
Département d'Anesthésie-Réanimation, Hôpital de Bicêtre, Université Paris-Sud, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, Paris, France.
Jean-Xavier
JX
Mazoit
Thermo Fisher Scientific, Asnières sur Seine, France.
Homa
H
Rafi
Département d'Anesthésie-Réanimation, Hôpital de Bicêtre, Université Paris-Sud, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, Paris, France.
Jacques
J
Duranteau
D053607:Adrenomedullin / Q000097:blood*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001810:Blood Volume / Q000502:physiology*; D001811:Blood Volume Determination / Q000379:methods; D016638:Critical Illness / Q000628:therapy*; D045604:Extracellular Fluid / Q000378:metabolism*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014882:Water-Electrolyte Balance / Q000502:physiology*; D055815:Young Adult
D015415:Biomarkers; D053607:Adrenomedullin
Adrenomedullin; Fluid balance; Fluid overload; Intensive care unit; MR-proADM; Plasma biomarker; Sodium overload