title: Adrenomedullin Is Associated With Surgical Trauma and Impaired Renal Function in Vascular Surgery Patients.
abstract: Patients undergoing vascular surgery are prone to perioperative organ injury because of both higher prevalence of cardiovascular risk factors and the extent of surgery. Early detection of organ failure is essential to facilitate appropriate medical care. Midregional pro-adrenomedullin (MR-proADM) has been investigated in acute medical care settings to guide clinical decision-making regarding patient pathways and to identify patients prone to imminent cardiovascular or inflammatory complications. In this study, we evaluated the impact of perioperative MR-proADM levels as an early marker of perioperative cardiovascular and inflammatory stress reactions and kidney injury.
  The study was conducted as a monocentric, prospective, noninterventional trial at Hannover Medical School, Germany. A total of 454 consecutive patients who underwent open vascular surgery were followed from the day prior to until 30 days after surgery. The composite primary end point was defined as the occurrence of major adverse cardiac events (MACEs), acute kidney injury (AKI), or systemic inflammatory response syndrome (SIRS). Measurements were correlated with both medical history and postoperative MACE, AKI, or SIRS using univariate and multivariate regression analysis.
  One hundred thirty-nine (31%) of the patients reached the primary end point within the study interval. Midregional pro-adrenomedullin change was associated with the combined primary end point and with the intensity of surgical trauma. Midregional pro-adrenomedullin change was increased in patients reaching the secondary end points, SIRS (optimal cutoff: 0.2 nmol/L) and AKI (optimal cutoff: 0.7 nmol/L), but not in patients with MACEs.
  Increased levels of MR-proADM within the perioperative setting (1) were linked to the invasiveness of surgery and (2) identified patients with ongoing loss of renal function. Increased MR-proADM levels may therefore identify a subgroup of patients prone to excessive cardiovascular stress but did not directly correlate with adverse cardiac events. Consistently low levels of MR-proADM may identify a subgroup of patients with acceptable low risk to guide discharge from high-density care units.
authors.affiliation: 1 Department of Anesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany.
authors.forename: Hans-Jörg
authors.initials: HJ
authors.lastname: Gillmann
authors.affiliation: 1 Department of Anesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany.
authors.forename: Antje
authors.initials: A
authors.lastname: Meinders
authors.affiliation: 1 Department of Anesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany.|2 Department of Anesthesiology, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Larmann
authors.affiliation: 3 Department of Medicine, Perioperative Inflammation and Infection, Faculty of Medicine and Health Sciences, University of Oldenburg, Oldenburg, Germany.
authors.forename: Bianca
authors.initials: B
authors.lastname: Sahlmann
authors.affiliation: 4 Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Claudia
authors.initials: C
authors.lastname: Schrimpf
authors.affiliation: 4 Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Aper
authors.affiliation: 5 Department of Clinical Chemistry, Hannover Medical School, Hannover, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Lichtinghagen
authors.affiliation: 6 Department of Vascular Surgery, Klinikum Peine, Peine, Germany.
authors.forename: Omke E
authors.initials: OE
authors.lastname: Teebken
authors.affiliation: 3 Department of Medicine, Perioperative Inflammation and Infection, Faculty of Medicine and Health Sciences, University of Oldenburg, Oldenburg, Germany.
authors.forename: Gregor
authors.initials: G
authors.lastname: Theilmeier
mesh_terms: D053607:Adrenomedullin / Q000097:blood*; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D019091:Critical Pathways; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000097:blood* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D051437:Renal Insufficiency / Q000097:blood*; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood*; D014656:Vascular Surgical Procedures / Q000009:adverse effects*
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D011498:Protein Precursors; C574167:mid-regional pro-adrenomedullin, human; D053607:Adrenomedullin
keywords: acute kidney injury; adrenomedullin; myocardial infarction; perioperative care; perioperative risk prediction; systemic inflammatory response syndrome; vascular surgery