Mid-regional proadrenomedullin: An early marker of response in critically ill patients with severe community-acquired pneumonia?
José Manuel Pereira,Ana Azevedo,Carla Basílio,Conceição Sousa-Dias,Paulo Mergulhão,José Artur Paiva +5 more
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TLDR
In SCAP patients, a decrease in MR-proADM serum levels in the first 48h after ICU admission was a good predictor of clinical response and better outcome.Abstract:
Background Mid-regional proadrenomedullin (MR-proADM) is a novel biomarker with potential prognostic utility in patients with community-acquired pneumonia (CAP). Purpose To evaluate the value of MR-proADM levels at ICU admission for further severity stratification and outcome prediction, and its kinetics as an early predictor of response in severe CAP (SCAP). Materials and methods Prospective, single-center, cohort study of 19 SCAP patients admitted to the ICU within 12 h after the first antibiotic dose. Results At ICU admission median MR-proADM was 3.58 nmol/l (IQR: 2.83–10.00). No significant association was found between its serum levels at admission and severity assessed by SAPS II (Spearman's correlation = 0.24, p = 0.31) or SOFA score (SOFA p = 0.74). Hospital and one-year mortality were 26% and 32%, respectively. No significant difference in median MR-proADM serum levels was found between survivors and non-survivors and its accuracy to predict hospital mortality was bad (aROC 0.53). After 48 h of antibiotic therapy, MR-proADM decreased in all but 5 patients (median −20%; IQR −56% to +0.1%). Its kinetics measured by the percent change from baseline was a good predictor of clinical response (aROC 0.80). The best discrimination was achieved by classifying patients according to whether MR-proADM decreased or not within 48 h. No decrease in MR-proADM serum levels significantly increased the chances of dying independently of general severity (SAPS II-adjusted OR 174; 95% CI 2–15,422; p = 0.024). Conclusions In SCAP patients, a decrease in MR-proADM serum levels in the first 48 h after ICU admission was a good predictor of clinical response and better outcome.read more
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The use of mid-regional proadrenomedullin to identify disease severity and treatment response to sepsis - a secondary analysis of a large randomised controlled trial
Gunnar Elke,Frank Bloos,Darius Cameron Wilson,Frank M. Brunkhorst,Josef Briegel,Konrad Reinhart,Markus Loeffler,Stefan Kluge,Axel Nierhaus,Ulrich Jaschinski,Onnen Moerer,Andreas Weyland,Patrick Meybohm +12 more
TL;DR: MR-proADM identifies disease severity and treatment response more accurately than established biomarkers and scores, adding additional information to facilitate rapid clinical decision-making and improve personalised sepsis treatment.
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Biomarkers in Pneumonia-Beyond Procalcitonin.
Meropi Karakioulaki,Daiana Stolz +1 more
TL;DR: This review discusses this rapidly evolving area and summarizes the application of novel biomarkers that appear to be promising for the accurate diagnosis and risk stratification of pneumonia.
Journal ArticleDOI
Mid-Regional Pro-Adrenomedullin (MR-proADM) as a Biomarker for Sepsis and Septic Shock: Narrative Review
TL;DR: In this paper, a narrative review was conducted to assess the role of mid-regional pro-adrenomedullin (MR-proADM) as a biomarker for sepsis and septic shock.
Journal ArticleDOI
Severe community-acquired pneumonia: optimal management.
Davide Leoni,Jordi Rello +1 more
TL;DR: Precision medicine applied to risk stratification and diagnosis, together with rapid microbiologic molecular testing, may contribute to optimizing the management of CAP, with potential additional reduction of mortality rates.
Journal ArticleDOI
Biomarker-Guided Individualization of Antibiotic Therapy.
Linda B. S. Aulin,Dylan W. de Lange,Mohammed A A Saleh,Piet H. van der Graaf,Swantje Völler,J. G. Coen van Hasselt +5 more
TL;DR: In this paper, the authors discuss the use and evidence of currently available biomarker-based approaches to inform antibiotic treatment, and also include a discussion on how treatment response biomarker data from preclinical, healthy volunteer, and patient-based studies can be further characterized using pharmacometric and system pharmacology based modeling approaches.
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