Circulating Biologically Active Adrenomedullin Predicts Organ Failure and Mortality in Sepsis

Ann Lab Med. 2019 Sep;39(5):454-463. doi: 10.3343/alm.2019.39.5.454.


Background: Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Biologically active adrenomedullin (bio-ADM) is an emerging biomarker for sepsis. We explored whether bio-ADM concentration could predict severity, organ failure, and 30-day mortality in septic patients.

Methods: In 215 septic patients (109 patients with sepsis; 106 patients with septic shock), bio-ADM concentration was measured at diagnosis of sepsis, using sphingotest bio-ADM (Sphingotec GmbH, Hennigsdorf, Germany) and analyzed in terms of sepsis severity, vasopressor use, and 30-day mortality. The number of organ failures, sequential (sepsis-related) organ failure assessment (SOFA) score, and 30-day mortality were compared according to bio-ADM quartiles.

Results: Bio-ADM concentration was significantly higher in patients with septic shock, vasopressor use, and non-survivors than in patients with solitary sepsis, no vasopressor use, and survivors, respectively (all P<0.0001). Bio-ADM quartiles were associated with the number of organ failures (P<0.0001), as well as SOFA cardiovascular, renal, coagulation, and liver subscores (all P<0.05). The 30-day mortality rate showed a stepwise increase in each bio-ADM quartile (all P<0.0001). Bio-ADM concentration and SOFA score equally predicted the 30-day mortality (area under the curve: 0.827 vs 0.830).

Conclusions: Bio-ADM could serve as a useful and objective biomarker to predict severity, organ failure, and 30-day mortality in septic patients.

Keywords: Bio-ADM; Mortality; Organ failure; Sepsis.

MeSH terms

  • Adrenomedullin / blood*
  • Aged
  • Area Under Curve
  • Female
  • Humans
  • Male
  • Middle Aged
  • Multiple Organ Failure / etiology*
  • Proportional Hazards Models
  • ROC Curve
  • Sepsis / complications
  • Sepsis / diagnosis*
  • Sepsis / mortality
  • Severity of Illness Index
  • Shock, Septic / complications
  • Shock, Septic / diagnosis
  • Shock, Septic / mortality
  • Survival Rate


  • Adrenomedullin