title: Level of adrenomedullin in cases with adrenal defficiency and its relation to mortality in patients with sepsis.
abstract: BACKGROUND
  The aim of this study was to determine the prognostic value of adrenomedullin, after evaluation of adrenal function in sepsis patients. We also evaluated other prognostic factors such as APACHE II score, proBNP, and CRP and their prediction in mortality.
  
  
  METHODS
  This is a prospective, observational study. We enrolled 48 patients, who were admitted to the intensive care unit due to sepsis according to surviving sepsis campaign criteria.
  
  
  RESULTS
  ADM median value was 60.8 ng/L in patients with normal adrenal function, and 20.1 ng/L in patients who had adrenal deficiency. With adequate adrenal response there was a linear and statistically significant relationship between adrenomedullin and mortality (p< 0.001). The median ADM level was 41.7 ng/L among non-survivors and 13.9 ng/L among survivors (p< 0.001). The median APACHE II score was 27.8 in non-survivors and 16.9 in survivors (p= 0.001). We also done ROC curve analysis; when ADM level was > 30.19 ng/L (sensitivity: 73.0%, specificity: 100%), APACHE II score was > 21 (sensitivity: 93.3%, specificity: 84.8%), and proBNP > 3736 pg/mL (sensitivity: 73.3%, specificity: 93.9%).
  
  
  CONCLUSIONS
  Without evaluation of adrenal function adrenomedullin should not be used, in predicting mortality of sepsis.
authors.affiliation: Clinic of Chest Diseases, Baskent University Istanbul Hospital, Istanbul, Turkey. drbaranbalcan@yahoo.com.
authors.forename: Baran
authors.initials: B
authors.lastname: Balcan
authors.forename: Şehnaz
authors.initials: Ş
authors.lastname: Olgun
authors.forename: Türkay
authors.initials: T
authors.lastname: Akbaş
authors.forename: Emel
authors.initials: E
authors.lastname: Eryüksel
authors.forename: Sait
authors.initials: S
authors.lastname: Karakurt
mesh_terms: D018806:APACHE; D053607:Adrenomedullin / Q000097:blood*; D000368:Aged; D015415:Biomarkers / Q000097:blood; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D018805:Sepsis / Q000097:blood* / Q000401:mortality*
chemical_list: D015415:Biomarkers; D053607:Adrenomedullin