Mid-regional pro-adrenomedullin as a prognostic marker in sepsis: an observational study

Crit Care. 2005;9(6):R816-24. doi: 10.1186/cc3885. Epub 2005 Nov 15.


Introduction: Measurement of biomarkers is a potential approach to early assessment and prediction of mortality in patients with sepsis. The aim of the present study was to evaluate the prognostic value of mid-regional pro-adrenomedullin (MR-proADM) levels in a cohort of medical intensive care patients and to compare it with other biomarkers and physiological scores.

Method: We evaluated blood samples from 101 consecutive critically ill patients admitted to the intensive care unit and from 160 age-matched healthy control individuals. The patients had initially been enrolled in a prospective observational study investigating the prognostic value of endocrine dysfunction in critically ill patients ("PEDCRIP" Study). The prognostic value of MR-proADM levels was compared with those of two physiological scores and of various biomarkers (for example C-reactive Protein, IL-6, procalcitonin). MR-proADM was measured in EDTA plasma from all patients using a new sandwich immunoassay.

Results: On admission, 53 patients had sepsis, severe sepsis, or septic shock, and 48 had systemic inflammatory response syndrome. Median MR-proADM levels on admission (nmol/l [range]) were 1.1 (0.3-3.7) in patients with systemic inflammatory response syndrome, 1.8 (0.4-5.8) in those with sepsis, 2.3 (1.0-17.6) in those with severe sepsis and 4.5 (0.9-21) in patients with septic shock. In healthy control individuals the median MR-proADM was 0.4 (0.21-0.97). On admission, circulating MR-proADM levels in patients with sepsis, severe sepsis, or septic shock were significantly higher in nonsurvivors (8.5 [0.8-21.0]; P < 0.001) than in survivors (1.7 [0.4-17.6]). In a receiver operating curve analysis of survival of patients with sepsis, the area under the curve (AUC) for MR-proADM was 0.81, which was similar to the AUCs for IL-6, Acute Physiology and Chronic Health Evaluation II score and Simplified Acute Physiology Score II. The prognostic value of MR-proADM was independent of the sepsis classification system used.

Conclusion: MR-proADM may be helpful in individual risk assessment in septic patients.

Publication types

  • Comparative Study
  • Evaluation Study

MeSH terms

  • Adrenomedullin
  • Adult
  • Aged
  • Aged, 80 and over
  • Biomarkers / blood
  • Cohort Studies
  • Female
  • Humans
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care
  • Prognosis
  • Protein Precursors / blood*
  • Proteins
  • Reference Values
  • Sensitivity and Specificity
  • Sepsis / blood*
  • Sepsis / classification
  • Sepsis / diagnosis*
  • Sepsis / epidemiology
  • Sepsis / therapy
  • Severity of Illness Index
  • Survival Analysis
  • Switzerland / epidemiology


  • Biomarkers
  • Protein Precursors
  • Proteins
  • proadrenomedullin
  • Adrenomedullin