title: MR-proADM: A New Biomarker for Early Diagnosis of Sepsis in Burned Patients.
abstract: Mid regional pro-adrenomedullin (MR-proADM) has been used as a marker of sepsis, but its dynamics and role in a burn injury setting has not been tested. In a prospective observational study, we included 42 consecutive patients with >15% TBSA. Daily blood specimens collected over the initial 20 days of treatment were submitted for laboratory analysis of MR-proADM and procalcitonin (PCT) via immunoluminometric sandwich assay (Kryptor, BRAHMS, Berlin, Germany). In patients with an absence of sepsis, an initial increase in MR-proADM and PCT levels was noted post-burn injury, peaking on the second day postadmission and thereafter demonstrated a continued decline in MR-proADM and PCT levels. In those patients who went on to develop sepsis (n = 27, 64.3%), the levels of MR-proADM and PCT were significantly higher (P < .001) on days categorized as septic, than on days categorized as nonseptic. The increase in PCT levels was noted on the first day to be categorized as septic. In contrast, the MR-proADM levels demonstrated an increase one day earlier. The optimal relationship between the specificity and sensitivity of MR-proADM and PCT for the detection of sepsis was an increase of 31% and at least 0.015 nmol/L (area under curve 0.76) or of >39% and at least 0.15 µg/L (area under the curve 0.83), respectively. Burn injury is associated with increased levels of MR-proADM. Subsequent increases may be considered as diagnostic of sepsis onset. In this context, PCT displayed higher specificity and sensitivity, while MR-proADM may be more suitable for the early recognition of sepsis (ClinicalTrials.gov number, NCT01055587).
authors.affiliation: From the *Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, St. Georg Hospital gGmbH Leipzig, Germany; and †Department of Plastic and Handsurgery with Burn Care Unit, St. Georg Hospital gGmbH Leipzig, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Gille
authors.forename: Hanfried
authors.initials: H
authors.lastname: Ostermann
authors.forename: Adrian
authors.initials: A
authors.lastname: Dragu
authors.forename: Armin
authors.initials: A
authors.lastname: Sablotzki
mesh_terms: D053607:Adrenomedullin / Q000097:blood*; D001681:Biological Assay; D015415:Biomarkers / Q000097:blood; D002056:Burns / Q000097:blood* / Q000628:therapy; D042241:Early Diagnosis; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D010446:Peptide Fragments / Q000097:blood*; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D018805:Sepsis / Q000097:blood* / Q000628:therapy*
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D011498:Protein Precursors; C574167:mid-regional pro-adrenomedullin, human; D053607:Adrenomedullin