The use of mid-regional proadrenomedullin to identify disease severity and Treatment response to sepsis - a secondary analysis of a large randomised controlled trial
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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. / Elke, Gunnar; Bloos, Frank; Wilson, D.; Brunkhorst, Frank M; Briegel, Josef; Reinhart, Konrad; Loeffler, Markus; Kluge, Stefan; Nierhaus, Axel; Jaschinski, Ulrich; Moerer, Onnen; Weyland, Andreas; Meybohm, Patrick; SepNet Critical Care Trials Group.
in: CRIT CARE, Jahrgang 22, Nr. 1, 21.03.2018, S. 79.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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T1 - The use of mid-regional proadrenomedullin to identify disease severity and Treatment response to sepsis - a secondary analysis of a large randomised controlled trial
AU - Elke, Gunnar
AU - Bloos, Frank
AU - Wilson, D.
AU - Brunkhorst, Frank M
AU - Briegel, Josef
AU - Reinhart, Konrad
AU - Loeffler, Markus
AU - Kluge, Stefan
AU - Nierhaus, Axel
AU - Jaschinski, Ulrich
AU - Moerer, Onnen
AU - Weyland, Andreas
AU - Meybohm, Patrick
AU - SepNet Critical Care Trials Group
PY - 2018/3/21
Y1 - 2018/3/21
N2 - Background: This study assessed the ability of mid-regional proadrenomedullin (MR-proADM) in comparison to conventional biomarkers (procalcitonin (PCT), lactate, C-reactive protein) and clinical scores to identify disease severity in patients with sepsis.Methods: This is a secondary analysis of a randomised controlled trial in patients with severe sepsis or septic shock across 33 German intensive care units. The association between biomarkers and clinical scores with mortality was assessed by Cox regression analysis, area under the receiver operating characteristic and Kaplan-Meier curves. Patients were stratified into three severity groups (low, intermediate, high) for all biomarkers and scores based on cutoffs with either a 90% sensitivity or specificity.Results: 1089 patients with a 28-day mortality rate of 26.9% were analysed. According to the Sepsis-3 definition, 41.2% and 58.8% fulfilled the criteria for sepsis and septic shock, with respective mortality rates of 20.0% and 32.1%.MR-proADM had the strongest association with mortality across all Sepsis-1 and Sepsis-3 subgroups and could facilitate a more accurate classification of low (e.g. MR-proADM vs. SOFA: N = 265 vs. 232; 9.8% vs. 13.8% mortality)and high (e.g. MR-proADM vs. SOFA: N = 161 vs. 155; 55.9% vs. 41.3% mortality) disease severity. Patients with decreasing PCT concentrations of either ≥ 20% (baseline to day 1) or ≥ 50% (baseline to day 4) but continuouslyhigh MR-proADM concentrations had a significantly increased mortality risk (HR (95% CI): 19.1 (8.0–45.9) and 43.1 (10.1–184.0)).Conclusions: 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.
AB - Background: This study assessed the ability of mid-regional proadrenomedullin (MR-proADM) in comparison to conventional biomarkers (procalcitonin (PCT), lactate, C-reactive protein) and clinical scores to identify disease severity in patients with sepsis.Methods: This is a secondary analysis of a randomised controlled trial in patients with severe sepsis or septic shock across 33 German intensive care units. The association between biomarkers and clinical scores with mortality was assessed by Cox regression analysis, area under the receiver operating characteristic and Kaplan-Meier curves. Patients were stratified into three severity groups (low, intermediate, high) for all biomarkers and scores based on cutoffs with either a 90% sensitivity or specificity.Results: 1089 patients with a 28-day mortality rate of 26.9% were analysed. According to the Sepsis-3 definition, 41.2% and 58.8% fulfilled the criteria for sepsis and septic shock, with respective mortality rates of 20.0% and 32.1%.MR-proADM had the strongest association with mortality across all Sepsis-1 and Sepsis-3 subgroups and could facilitate a more accurate classification of low (e.g. MR-proADM vs. SOFA: N = 265 vs. 232; 9.8% vs. 13.8% mortality)and high (e.g. MR-proADM vs. SOFA: N = 161 vs. 155; 55.9% vs. 41.3% mortality) disease severity. Patients with decreasing PCT concentrations of either ≥ 20% (baseline to day 1) or ≥ 50% (baseline to day 4) but continuouslyhigh MR-proADM concentrations had a significantly increased mortality risk (HR (95% CI): 19.1 (8.0–45.9) and 43.1 (10.1–184.0)).Conclusions: 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.
U2 - 10.1186/s13054-018-2001-5
DO - 10.1186/s13054-018-2001-5
M3 - SCORING: Journal article
VL - 22
SP - 79
JO - CRIT CARE
JF - CRIT CARE
SN - 1364-8535
IS - 1
ER -