Prognostic Role of Serum Adrenomedullin in Patients with Ventilator Associated Pneumonia
Abstract
:Highlights
- Ventilator associated pneumonia (VAP) is a common type of sepsis in mechanically ventilated patients that can progress to septic shock and increased mortality.
- Adrenomedullin (ADM) was found to be elevated in septic patients, so we explored the possible prognostic role of adrenomedullin in VAP patients.
- A total of 140 mechanically ventilated patients with proven VAP after medical ICU admission were consecutively enrolled into this prospective observational study.
- Serum ADM on enrollment could predict the unfavorable outcome with a sensitivity of 96.25%. After 5 days, it showed a sensitivity of 57.5% and a specificity of 100%.
- We found that serum adrenomedullin when measured at days 0 and 5 of VAP diagnosis may serve as an early predictor of unfavorable outcome (prolonged mechanical ventilation, septic shock, and mortality).
Abstract
1. Introduction
2. Patients and Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
References
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Extubation (n = 60) | Prolonged MV (n = 28) | Septic Shock (n = 20) | Died (n = 32) | χ2 | p | |
---|---|---|---|---|---|---|
Age (years): Range Mean ± SD | 19–86 | 28–70 | 50–66 | 51–73 | (F) = | 0.061 |
51.3 ± 24.6 | 50.1 ± 14.9 | 58.0 ± 6.22 | 60.4 ± 7.8 | 2.515 | ||
Sex: Male (No%) Female (No%) | 32 (53.3) | 16 (57.1) | 12 (60.0) | 22 (68.8) | 2.085 | 0.555 |
28 (46.7) | 12 (42.9) | 8 (40.0) | 10 (31.3) | |||
Comorbidities: DM (%) HTN (%) IHD (%) COPD (%) | 44 (73.3) | 20 (71.4) | 15 (75.0) | 23 (71.86) | 2.101 | 0.989 |
38 (63.3) | 17 (60.7) | 12 (60.0) | 17 (53.13) | |||
27 (45.0) | 12 (42.9) | 8 (40.0) | 13 (40.63) | |||
12 (20.0) | 7 (25.0) | 3 (15.0) | 3 (9.38) | |||
MV days before VAP Range Mean ± SD | 2–5 | 3–5 | 2–6 | 2–4 | (F) = 2.703 | 0.641 |
3.1 ± 0.98 | 2.58 ± 1.03 | 2.06 ± 1.9 | 3.06 ± 0.08 | |||
Main diagnosis: Coma (%) Respiratory failure (%) Sepsis (%) Toxidromes (%) | 31 (51.67) | 12 (42.86) | 11 (55.0) | 18 (56.25) | 2.246 | 0.989 |
12 (20.0) | 7 (25.0) | 3 (15.0) | 5 (15.63) | |||
12 (20.0) | 5 (17.86) | 4 (20.0) | 6 (18.75) | |||
5 (8.3) | 4 (14.29) | 2 (10.0) | 3 (9.38) | |||
Culture of Tracheal Aspirate at day 0: MRSA (%) Pseudomonas (%) Klebsiella (%) E-coli (%) Acinetobacter (%) Candida (%) Contaminated (%) | 4 (6.7) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 4.015 | 0.999 |
0 (0.0) | 0 (0.0) | 4 (14.3) | 0 (0.0) | |||
20 (33.3) | 20 (71.4) | 12 (42.8) | 24 (75.0) | |||
4 (6.7) | 0 (0.0) | 0 (0.0) | 4 (12.5) | |||
32 (53.3) | 8 (28.6) | 12 (42.8) | 4 (12.5) | |||
0 (0.0) | 0 (0.0) | 0 (0.0) | 4 (12.5) | |||
4 (6.7) | 0 (0.0) | 0 (0.0) | 0 (0.0) |
Parameter: | Time Interval | Extubation (n = 60) | Prolonged MV (n = 28) | Septic Shock (n = 20) | Died (n = 32) | F/H | p |
---|---|---|---|---|---|---|---|
APACHE II (Mean ± SD) | Day 0 | 11.1 ± 4.6 | 12.9 ± 3.1 | 17.8 ± 5.4 | 17.1 ± 4.4 | 19.316 * | <0.001 * |
pExtupation | 0.323 | <0.001 * | <0.001 * | ||||
Sig. bet. Grps | p1 = 0.001 *, p2 = 0. 002 *, p3 = 0.950 | ||||||
(Mean ± SD) pExtupation Sig. bet. Grps | Day 5 | 10.9 ±3.9 | 13.6 ± 2.9 | 21.3 ± 3.2 | 20.6 ± 2.9 | 20.932 * | <0.001 * |
0.291 | <0.001 * | <0.001 * | |||||
p1 < 0.001 *, p2 = 0.001 *, p3 = 0.694 | |||||||
CRP (mg/L) | |||||||
(Mean ± SD) | Day 0 | 37.3 ± 33.7 | 45.7 ± 8.5 | 44.0 ± 44.4 | 44.6 ± 14.7 | 0.806 | 0.493 |
(Mean ± SD) | Day 5 | 18.6 ± 7.54 | 28.3 ± 9.5 | 52.0 ± 19.2 | 34.4 ± 15.8 | 59.320 * | <0.001 * |
pExtupation | <0.001 * | <0.001 * | <0.001 * | ||||
Sig. bet. Grps | p1 < 0.001 *, p2 = 0.300, p3 = 0.006 * | ||||||
Lactate (mmol/L) | |||||||
(Mean ± SD) | Day 0 | 2.39 ± 0.38 | 2.75 ± 0.28 | 2.78 ± 0.42 | 2.97 ± 0.30 | 21.535 * | <0.001 * |
pExtupation | <0.001 * | <0.001 * | <0.001 * | ||||
Sig. bet. Grps | p1 = 0.994, p2 = 0.235, p3 = 0.235 | ||||||
(Mean ± SD) | Day 5 | 2.08 ± 0.35 | 2.7 ± 0.54 | 3.64 ± 0.89 | 3.33 ± 0.66 | 49.363* | < 0.001* |
pExtupation | <0.001 * | <0.001 * | <0.001 * | ||||
Sig. bet. Grps | p1 < 0.001 *, p2 < 0.001 *, p3 = 0.855 | ||||||
SOFA score | |||||||
(Mean ± SD) | Day 0 | 6.07 ± 1.62 | 6.7 ± 2.16 | 7.0 ± 2.25 | 5.88 ± 1.29 | 6.368 | 0.095 |
(Mean ± SD) | Day 5 | 3.60 ± 1.80 | 4.29 ± 1.86 | 6.60 ± 2.64 | 6.38 ± 2.03 | 41.485 * | <0.001 * |
pExtupation | <0.001 * | <0.001 * | <0.001 * | ||||
Sig. bet. Grps | p1 = 0.001 *, p2 = 0.001 *, p3 = 0.892 | ||||||
Adrenomedullin (pg/mL) | |||||||
(Mean ± SD) | Day 0 | 19.1 ± 8.42 | 34.1 ± 18.2 | 42.4 ± 26.7 | 49.8 ± 23.0 | 46.703* | <0.001 * |
pExtupation | <0.001 * | <0.001 * | <0.001 * | ||||
Sig. bet. Grps | p1 = 0.579, p2 = 0.027*, p3 = 0.149 | ||||||
(Mean ± SD) | Day 5 | 7.82 ± 5.16 | 18.5 ± 9.66 | 52.5 ± 35.2 | 43.9 ± 29.1 | 74.411 * | <0.001 * |
pExtupation | <0.001 * | <0.001 * | <0.001 * | ||||
Sig. bet. Grps | p1 = 0.016 *, p2 = 0.010 *, p3 = 0.897 |
Parameter: | Adrenomedullin (ADM) | |||
---|---|---|---|---|
Day 0 | Day 5 | |||
rs | p | rs | p | |
CRP | 0.085 $ | 0.320 | 0.702 $ | <0.001 * |
SOFA score | 0.262 # | 0.049 * | 0.820 # | <0.001 * |
APACHE II score | 0.437 # | <0.001 * | 0.814 # | <0.001 * |
Lactate | 0.992 $ | <0.001 * | 0.990 $ | <0.001 * |
Extubation (n = 60) | Prolonged M.V (n = 28) | Septic Shock (n = 20) | Died (n = 32) | F | p | |
---|---|---|---|---|---|---|
M.V (days) | ||||||
(Mean ± SD) | 8.6 ± 1.09 | 14.4 ± 1.20 | 16.6 ± 1.90 | 14.38 ± 1.90 | 227.81 * | <0.001 * |
pExtupation | <0.001 * | <0.001 * | <0.001 * | |||
Sig. bet. Grps | p1 < 0.001 *, p2 = 0.999, p3 < 0.001 * | |||||
ICU stay (days) | ||||||
(Mean ± SD) | 11.13 ± 0.72 | 18.7 ± 1.5 | 20.8 ± 1.77 | 14.38 ± 1.90 | 337.6 * | <0.001 * |
pExtupation | <0.001 * | <0.001 * | <0.001 * | |||
Sig. bet. Grps | p1 < 0.001 *, p2 < 0.001 *, p3 < 0.001 * |
Day 0: | AUC | p | 95% C.I | Cut off | Sensitivity | Specificity | PPV | NPV |
---|---|---|---|---|---|---|---|---|
Adrenomedullin | 0.818 * | <0.001 * | 0.751–0.885 | >16 | 96.25 | 40.0 | 68.1 | 88.9 |
SOFA | 0.555 | 0.266 | 0.459–0.651 | ≤5 | 50.0 | 60.0 | 62.5 | 47.4 |
Lactate | 0.817 * | <0.001 * | 0.749–0.885 | >2.9 | 55.0 | 93.33 | 91.7 | 60.9 |
CRP | 0.552 | 0.296 | 0.450–0.654 | >22 | 60.0 | 66.67 | 70.6 | 55.6 |
APACHE II | 0.747 * | <0.001 * | 0.667–0.826 | >12 | 65.0 | 60.0 | 68.4 | 56.3 |
Day 5: | ||||||||
Adrenomedullin | 0.901 * | <0.001 * | 0.853–0.949 | >20 | 57.50 | 100.0 | 100.0 | 63.8 |
SOFA Lactate CRP APACHE II | 0.752 * 0.893 * 0.835 * 0.747 * | <0.001 * <0.001 * <0.001 * <0.001 * | 0.673–0.830 0.842–0.943 | >5 >2.5 | 55.0 70.0 | 73.33 93.33 | 73.3 93.3 | 55.0 70.0 |
0.768–0.902 0.667–0.826 | >34 >12 | 55.0 65.0 | 93.33 60.0 | 91.7 68.4 | 60.9 56.3 |
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Helmy, T.A.; Tammam, H.H.; Leuis, M.E.; Beshey, B.N. Prognostic Role of Serum Adrenomedullin in Patients with Ventilator Associated Pneumonia. Adv. Respir. Med. 2022, 90, 349-359. https://doi.org/10.3390/arm90040044
Helmy TA, Tammam HH, Leuis ME, Beshey BN. Prognostic Role of Serum Adrenomedullin in Patients with Ventilator Associated Pneumonia. Advances in Respiratory Medicine. 2022; 90(4):349-359. https://doi.org/10.3390/arm90040044
Chicago/Turabian StyleHelmy, Tamer Abdallah, Haitham Hamdy Tammam, Michael Ebrahim Leuis, and Bassem Nashaat Beshey. 2022. "Prognostic Role of Serum Adrenomedullin in Patients with Ventilator Associated Pneumonia" Advances in Respiratory Medicine 90, no. 4: 349-359. https://doi.org/10.3390/arm90040044