Study On The Relationship Of Plasma Levels Pro-adrenomedullin And Sepsis, Multiple Organ Dysfunction Syndrome In Critical Ill Patients

Studying on the relationship of plasma levels pro-adrenomedullin and sepsis, multiple organ dysfunction syndrome in critical ill patients. The main work contained two parts as follows:1. Studying on the relationship of plasma levels pro-adrenomedullin and sepsis in critical ill patients.Objective1. To study the relationship of plasma levels of pro-adrenomedullin and acute physiology and chronic health evaluationⅡscore in critical ill patients of intensive care unit.2. To assess the clinical value of pro-adrenomedullin (pro-ADM) to the prognosis and risk stratification in sepsis.MethodsWe performed prospective trial, according to the international sepsis criteria, 51 critically ill patients admitted to the intensive care unit were classified into four groups: systemic inflammatory response syndrome (SIRS, 25), sepsis(12), severe sepsis(9) and septic shock(5). The levels of plasma pro-ADM was measured using a new sandwich immunoassay in each group, and compared with the other biomarkers (i.e. Procalcitonin, C-reactive protein and IL-6) and the acute physiology and chronic health evaluation (APACHE)Ⅱscore.Results1. Median pro-ADM concentration (ug/L)was 0.34 for SIRS, 2.23 for sepsis, 4.57 for severe sepsis and 8.21 for septic shock, the plasma concentration of pro-ADM exhibited a gradual increase,and the median pro-ADM value was highest in the septic shock group (P <0.05).2. Comparing with the other biomarkers, in the sepsis, severe sepsis and septic shock groups, the plasma concentration of pro-ADM in the nonsurvivors was significantly greater than in the survivors(P <0.05).3. Plasma pro-ADM levels showed positive correlation with APACHEⅡscores(P﹤0.05).4. By the receiver operating characteristic (ROC) plot analysis of pro-ADM in sepsis survival patients, the area under the ROC curve for pro-ADM was similar to the area under the ROC curve for PCT and APACHEⅡscore, and was significantly higher than the area under the ROC curve for CRP and IL-6.ConclusionThere is a positive correlation between plasma pro-ADM levels and APACHEⅡscore, the measurement of pro-ADM is a new and useful marker in sepsis prognosis and risk assessment.2. Studying on the relationship of plasma levels pro-adrenomedullin and multiple organ dysfunction syndrome in critical ill patients.ObjectiveTo evaluate the value of pro-adrenomedullin (pro-ADM) in prediction of multiple organ dysfunction syndrome in critical ill patients.MethodsFifty-one critically ill patients admitted to ICU were recruited, they were prospectively divided into MODS group and non-MODS group. The levels of plasma pro-ADM were determined in every patient using a new sandwich immunoassay. Acute Physiology and Chronic Health Evaluation (APACHE)Ⅱscores and sequential organ failure assessment (SOFA) scores were recorded and relationship between pro-ADM levels and APACHEⅡscores as well as SOFA analyzed.ResultsThe plasma pro-ADM levels of MODS group were significantly higher than non-MODS group [4.73(6.38) ug/L vs. 0.79(0.84) ug/L, P <0.001] and with the number of failing organ increased, plasma pro-ADM levels increased (P <0.001). Plasma pro-ADM levels showed positive correlation with APACHEⅡscores and SOFA scores(P <0.001).ConclusionThe levels of plasma pro-ADM has clinic valuable in prediction of MODS in critical ill patients.