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Abstract Introduction: A potentially new marker of cardiovascular diseases — proadrenomedullin is the precursor of adrenomedullin, which is a multifunctional peptide hormone, produced in most of the tissues in response to cellular stress, ischemia, and hypoxia. Methods: Ninety-three people, aged 51-79 years, were included in the study. Exclusion criteria were severe or corrected valvular disease, acute coronary syndrome, age ≥ 80 years, glomerular filtration rate < 45 ml/min, active infectious diseases, and cancer. The subjects were observed for adverse events, including reduced left ventricular ejection fraction (LVEF) by ≥ 10%, first incidence of atrial fibrillation (AF), and the necessity of using dopamine during hospitalization. Results: Use of pressure amines, occurrence of the first AF episode, and left ventricular dysfunction defined by a decrease in LVEF by at least 10% compared to the value before surgery were reported in the perioperative period. No death, sudden cardiac arrest with effective resuscitation, non-ST-elevation myocardial infarction, ST-elevation myocardial infarction, or heart failure were observed. Significantly higher proadrenomedullin concentration was observed in the group with reduced postoperative LVEF (1.68 vs. 0.77 nmol/l, P=0.005). The relative risk of a decrease in ejection fraction in the group of patients with proadrenomedullin concentration ≥ 0.77 nmol/l was more than twelve-fold higher (95% confidence interval 1.69-888.33; P=0.013) than in the group of patients with a concentration of proadrenomedullin < 0.77 nmol/l. Conclusion: The higher baseline concentration of proadrenomedullin has a predominantly predictive value of postoperative left ventricular systolic dysfunction.
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Objective:To investigate the predictive value of mid-regional proadrenomedullin (MR-proADM) on poor prognosis of low-risk patients with sepsis.Methods:This was a prospective cohort study. Patients with sepsis admitted to the Emergency Intensive Care Unit of China Rehabilitation Research Center from December 2018 to December 2020 were included in this study. The patients were divided into the low-risk group (SOFA≤7) and medium-high-risk group (SOFA>7) according to the sequential organ failure assessment (SOFA) score, and the clinical characteristics of the two groups were compared. Proportional hazards regression model (COX regression model) was used to investigate the risk factors of 28-day mortality in the low-risk and medium-high-risk group. The predictive ability of MR-proADM, C-reactive protein (CRP), lactic acid (Lac), interleukin-6 (IL-6), SOFA score, and acute physiology and chronic health evaluationⅡ (APACHE Ⅱ) score for the prognosis in each group was evaluated by receiver operating characteristic (ROC) curve. The outcomes of patients with different concentration of MR-proADM in the low-risk group were compared.Results:Totally 205 patients with sepsis were included, and the 28-day mortality was 41.0% (84/205). There were significant differences in the number of organ dysfunction, acute kidney injury, use of vasoactive drugs, Lac, IL-6, SOFA score and APACHEⅡ score between the two groups ( P<0.05). Cox regression model showed that age, MR-proADM, mechanical ventilation, IL-6 and APACHEⅡ score were the risk factors of 28-day death in the low-risk group, while MR-proADM, Lac, SOFA score and APACHEⅡ score were the risk factors of 28-day mortality in the medium-high-risk group. In each group, MR-proADM had a good predictive ability for the prognosis of patients with sepsis ( P<0.001). Especially in low-risk patients with sepsis, the predictive ability of MR-proADM was better than other indicators. Kaplan-Meier survival curve suggested that the patients with MR-proADM >2.53 nmol/L had worse prognosis than those with MR-proADM ≤2.53 nmol/L, and the difference was statistically significant ( P<0.001). In the low-risk group, the mortality of patients increased from 7.8% to 58.2% if MR-proADM >2.53 nmol/L. Conclusions:MR-proADM is a risk factor for 28-day mortality in patients with sepsis, and MR-proADM can early identify the poor prognosis of low-risk patients with sepsis.
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Objective:To explore the value of body temperature, pediatric clinical illness score(PCIS), white blood cell count (WBC), plasma C-reactive protein (CRP), procalcitonin (PCT) and pro-adrenomedullin (pro-ADM) in predicting nosocomial infection in PICU.Methods:From June 2016 to March 2017, the critically ill children in PICU of Children′s Hospital of Fudan University were selected and divided into nosocomial infection group and non nosocomial infection group according to the diagnostic criteria of nosocomial infection.The body temperature, PCIS, WBC, CRP, PCT and pro-ADM were recorded at 4 hours (T1), (48±1) hours (T2), (120±1) hours (T3) and (192±1) hours (T4) after admission, and their predictive value of each index, which was the closest time point (Th) to nosocomial infection was analyzed.Receiver-operating characteristic (ROC) curves were performed to calculate the areas under the curves (AUC), sensitivity and specificity, and multivariate Logistic regression analysis was used to study the risk factors of nosocomial infection.Results:A total of 85 cases were included, including 27 cases in nosocomial infection group and 58 cases in non nosocomial infection group.There was no significant difference in age, weight, body temperature, WBC, PCT, pro-ADM, primary disease and invasive operation between two groups (all P>0.05). There were significant differences in gender, PCIS, CRP, intubation rate and central venous catheterization rate ( P<0.05), when patients were admitted to PICU.At Th, the differences of body temperature, PCIS, CRP, PCT and pro-ADM between two groups were statistically significant ( P<0.05), as well as the AUC were 0.787, 0.755, 0.709, 0.704 and 0.809, respectively, as well as the best cut-off values for predicting nosocomial infection were 38.0 ℃, 87 points, 14.5 mg/L, 0.28 ng/mL and 0.67 nmol/L, respectively.There was no significant difference regarding WBC between two groups ( P>0.05). PCIS may be an independent risk factor for nosocomial infection( OR=0.978, 95% CI 95.9-99.9, P<0.05). Conclusion:Pro-ADM has high sensitivity and specificity in predicting nosocomial infection, and PCIS is an independent risk factor for nosocomial infection.
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Objective To investigate the significances of PAMP and NT-proBNP in predicting coronary artery injury in Kawasaki disease(KD).Methods A total of 196 cases of KD in this hospital from February 2014 to August 2015 were selected and divided into the KD injury group and KD non-injury group according to with orwithout coronary arterial injury.Contemporaneous 50 healthy children in the Child Health Care Center were selected as the control group.The plasma levels of PAMP and NT-proBNP were detected in 3 groups.Results Compared with the control group,the plasma levels of PAMP and NT-proBNP in the childrenpatients with KD were increased,moreover the KD injury group was higher than the KD non-injury group(P＜0.05).The plasma PAMP levels in KD children patients were positively correlated with NT-proBNP,white blood cell(WBC) count,neutrophil percentage and erythrocyte sedimentation rate(ESR)(P＜0.05),while were negatively correlated with the value of serum sodium and albumin(P＜0.05),the plasma levels of NT-proBNP were positively correlated white blood cell count,neutrophil percentage,C-reactive protein(CRP) and ESR(P＜0.05),while were negatively correlated with the levels of serum sodium and albumin(P＜0.05).The area under the curve(AUC) of plasma PAMP and NT-proBNP levels in predicting coronary artery damage in children patients with KD was 0.989,the sensitivity was 93.24％ and specificity was 93.65 ％.Conclusion The plasma levels of PAMP and NT-proBNP in children patients with acute phase of KD are elevated,which can serve as the predictive indicators of coronary artery lesion.
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PURPOSE: Sepsis is a major cause of neonatal morbidity and mortality. Early diagnosis is a major problem because of the lack of specific clinical signs. Therefore, a reliable diagnostic marker is needed to guide the use of antimicrobial agents. The objective of our study was to assess the value of proadrenomedullin (pro-ADM) in establishing the diagnosis and evaluating the prognosis of neonatal sepsis. METHODS: This study enrolled 60 newborn infants with sepsis proven with positive blood cultures and 30 healthy neonates. Complete blood count, C-reactive protein levels, and pro-ADM levels were obtained from all neonates. RESULTS: The pro-ADM levels were significantly higher (14.39±0.75 nmol/L) in the sepsis group than in the control group (3.12±0.23 nmol/L). The optimal cutoff value for pro-ADM was 4.3 nmol/L, with a sensitivity of 93.3% and a specificity of 86.7%. The pro-ADM levels were also higher in nonsurvivors (P=0.001). CONCLUSION: Pro-ADM can be used as a reliable biomarker for neonatal sepsis. High pro-ADM levels were associated with mortality and could be an early indicator of disease outcome.
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Humans , Infant, Newborn , Anti-Infective Agents , Blood Cell Count , C-Reactive Protein , Diagnosis , Early Diagnosis , Mortality , Prognosis , Sensitivity and Specificity , SepsisABSTRACT
Objective To study the change of mid-regional pro-adrenomedullin(MR-proADM) level in patients with chronic heart failure and its significance.Methods Randomly selected 330 patients with chronic heart failure,including 120 cases of grade Ⅱ and Ⅲ,90 cases of grade Ⅳ,90 cases were selected.,Within 24 h after the entry of the group and 7 d after symptom relieved,serum N-terminal pro-B-type natriuretic peptide(NT-proBNP),MR-proADM,cardiac ultrasound(left ventricular diameter(LVEDD) and left ventricular function(LVEF)) were measured.Ninety physical examination in the same period as healthy control during the same period.The change of MR-proADM level in patients with chronic heart failure and its significance were analyze.Results Compared with the healthy control group,the level of MR-proADM in patients with chronic heart failure(grade Ⅱ:(641.55±106.34) pmol/l;grade Ⅲ:(684.46±101.33) pmol/l;grade Ⅳ:(737.81±479.37) pmol/l) was significantly higher than that in the control group(610.22±60.84) pmol/l),the difference was statistically significant(F=5.33,P=0.001).At the same time,the level of MR-proADM was increased with the aggravation of heart failure,after drug treatment will decline((608.09±100.81),(617.64±94.32),(642.22±163.53) pmol/L).And MR-proADM levels were significantly positively correlated with NT-proBNP levels and NYHA classification in patients with heart failure(r=0.194,P=0.003;r=0.206,P=0.000).Conclusion MR-proADM has important guiding significance in the diagnosis,classification of patients with chronic heart failure.
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Objective To explore the relationship between preoperative serum pro-adrenomedullin (pro-ADM) in the patients with closed rupture of small intestine,and postoperative secondary abdominal infection,and to study the value of postoperative serum pro-ADM in assessment of severity of postoperative secondary abdominal infection of this patients.Methods Eighty-five patients with closed rupture of small intestine treated in the emergency surgery from June 2014 to May 2015 were selected.According to the presence of postoperative abdominal infection or not,these patients were divided into infection group and non-infection group.The infection group was further divided into SIRS,sepsis,severe sepsis,septic shock subgroups as per the severity of infection.The levels of serum pro-ADM,interleukin-6 (IL-6),C-reactive protein (CRP) were determined and the acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score was calculated at admission and the first day、the second day and the third day after operation.Comparisons of these biomarkers were carried out to find out the factors associated with postoperative abdominal infection.In addition,ROC curve was used to verify the factors for predicting the abdominal infection of these patients after operation.The relationship between serum levels of pro-ADM and APACHE Ⅱ score after operation was analyzed.The severity of abdominal infection after operation was assessed with laboratory findings.Results Compared with non-infection group,preoperative and postoperative serum pro-ADM (P =0.03,P ＜ 0.01),IL-6 (P =0.02,P ＜0.01) levels and APACHE Ⅱ scores (P ＜ 0.01,P ＜ 0.01) were significantly higher in infection group (P ＜ 0.05).In the infection groups,the postoperative levels of serum pro-ADM and APACHE Ⅱ scores were increased with the severity of infection increased (r =0.924),and the difference between the groups was statistically significant (P ＜ 0.05),but there were no significant differences in IL-6 and CRP levels between two groups.Conclusion (1) The serum levels of pro-ADM before operation has value in predicting the genesis of abdominal infection in these patients after operation.(2) The serum levels of pro-ADM after operation has value in severity assessment of abdominal infection in these patients after operation.
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ObjectiveTo explore the early diagnostic value of pro-adrenomedullin (pro-ADM) in sepsis. Methods A prospective study was conducted. Eighty-two patients with acute infection admitted to Department of Emergency of Shanxi Medical University Second Hospital from April 2013 to March 2014 were enrolled. According to the diagnostic criteria of sepsis, the patients with acute infection were divided into ordinary infection group [infection without systemic inflammatory response syndrome (SIRS),n = 25] and sepsis group (infection combined with SIRS, n = 57). According to degree of severity of sepsis, the latter group was subdivided into three subgroups: sepsis group (n = 22), severe sepsis group (n = 27) and septic shock group (n = 8). Twenty-four healthy persons were included to serve as healthy control group. The venous blood from all the research objects in hospital was collected within 24 hours. The levels of pro-ADM and procalcitonin ( PCT ) were determined by enzyme linked immunosorbent assay (ELISA), and acute physiology and chronic health evaluationⅡ (APACHEⅡ) score was recorded. The relationship between pro-ADM and PCT and also APACHEⅡ score was analyzed with Pearson correlation analysis. The receiver-operating characteristic curve (ROC) of pro-ADM and PCT were used to evaluate the diagnostic acuity of sepsis.Results The plasma levels of pro-ADM, PCT and APACHEⅡ score in sepsis group were significantly higher than those in ordinary infection group and healthy control group [pro-ADM (ng/L): 66.69±1.73 vs. 53.43±2.70, 45.87±1.43; PCT (ng/L):1 336.49±40.26 vs. 1 083.09±47.99, 959.04±37.53; APACHEⅡ score: 14.60±0.81 vs. 8.10±1.14, 3.00±1.15,allP< 0.01]. With the aggravation of sepsis, the levels of pro-ADM, PCT and APACHEⅡ score were gradually increased, and there were significant differences among sepsis, severe sepsis, and septic shock groups [pro-ADM (ng/L): 64.91±2.50, 73.56±2.80, 84.67±4.52; PCT (ng/L): 1 152.65±48.62, 1 233.93±63.06, 1 475.71±109.93;APACHEⅡ score: 12.91±1.15, 14.55±1.14, 19.37±2.40,P< 0.05 orP< 0.01]. Pearson correlation analysis results showed that the level of pro-ADM was positively related with PCT (r = 0.473,P = 0.006), and it was also positively correlated with APACHEⅡ score (r = 0.707,P = 0.008). ROC curve analysis showed that area under the ROC curve (AUC) of pro-ADM for diagnosis of sepsis was 0.823 (P = 0.003). When the cutoff value was 59.40 ng/L, the sensitivity was 80.7%, the specificity was 68.0%, the positive predictive value was 85.2%, and the negative predictive value was 60.7%. AUC of the PCT for diagnosis of sepsis was 0.653 (P = 0.043). When the cutoff value was 1 194.67 ng/L, the sensitivity was 68.4%, the specificity was 64.0%, the positive predictive value was 81.8%, and the negative predictive value was 44.7%. It was proved that the pro-ADM had a higher diagnostic value for sepsis than PCT.Conclusion The plasma levels of pro-ADM can be used as an early indicator in diagnosis and severity evaluation and prognosis in patients with sepsis .
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Objective To investigate the diagnostic value of serum proadrenomedullin( pro-ADM)in catheter related blood stream infection( CRBSI). Methods Prospective diagnostic test was performed with 76 cases patients with clinically suspected diagnosis of CRBSI,and the patients were divided into CRBSI group( n=25)and non-CRBSI group. Serum pro-ADM,procalcitonin( PCT),C-reactive protein( CRP)and white blood cell( WBC)levels were measured at the study entry and on the day of CRBSI suspicion. Results On the day of CRBSI suspicion,the levels of pro-ADM,PCT,CRP and WBC in the CRBSI group were(5. 17 ± 1. 28)nmol/L, 2. 29(1. 47-4. 28)μg/L,(102. 04 ± 51. 00)μg/L and(14. 66 ± 5. 09)× 109/L respectively,significantly higher than those in the non-CRBSI group((2. 83 ± 1. 25)nmol/L,2. 29(1. 4-4. 28)μg/L,(61. 43 ± 53. 52) mg/L and(11. 78 ± 3. 52)× 109/L respectively;t or Z=7. 636,-4. 777,3. 156,2. 882;P﹤0. 05). For the diagnosis of CRBSI,the area under the curve(AUC)of pro-ADM,PCT,CRP and WBC were 0. 89(95%CI 0. 82-0. 97),0. 84(95%CI 0. 75-0. 93),76(95%CI 0. 65-0. 86)and 0. 68(0. 54-0. 81)respectively. Taking pro-ADM with 4. 31 nmol/L as the cutoff value,the sensitivity,specificity,positive predictive value and negative predictive value were 76. 0%,84. 3%,70. 4% and 87. 8% respectively. Simultaneously,taking procalcitonin with 1. 52 μg/L as the cutoff value, the sensitivity and specificity was 81. 8% and 87. 0%respectively. Conclusion Serum level of pro-ADM in the diagnosis of CRBSI has good specificity. Simultaneous surveillance of serum pro-ADM and PCT may be helpful for the diagnosis of CRBSI in the early stage.
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The aim of this study was to clarify the prognostic value of serum pro- Adrenomedullin level (pro-ADM) and Anti thrombin level in neonatal sepsis. 40 term neonates with sepsis were enrolled in this study including 20 cases with mild sepsis and 20 cases with severe sepsis. Twenty healthy matched neonates served as a control group. Serum levels of Pro ADM and Antithrombin were measured in all patients and the control group. Serum Pro ADM level was higher in neonates with sepsis than control group, higher in severe than mild sepsis, and was higher in non survivors. Antithrombin concentrations were lower in sepsis cases than control, lower in severe than mild sepsis, and lower in non-survivors.
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There are numerous complex mechanisms contributing to the evolution of septic shock, and early diagnosis and intervention will improve the prognosis of patient with septic shock. Recently plasma concentrations of some bio-markers like pro-ADM,pro-ANP,pro-ET1 and copeptin are found increasing in patient with septic shock.The plasma concentrations of these bio-markers are positively related with the severity of infection.These bio-markers have long halflife and are easily assayed. They may be the new bio-markers for the early diagnosis of septic shock.
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Aim To study the effect of Peptide fragments that originate from the same proadrenomedullin on cAMP in rat aorta.Methods Isolated aortic tissues were exposed to ADM,PAMP and ADT for 2 h.The content of cAMP in the incubated media was assayed by radioimmunoassay.Results ① The content of cAMP in the aortic tissues that were exposed to ADM (10~(-7) and 10~(-8) mol·L~(-1)) was significantly increased. The content of cAMP in the aortic tissues stimulated by PAMP (10~(-8) mol·L~(-1))or ADT (10~(-8) mol·L~(-1))alone was significantly increased, compared with the control.② The content of cAMP was not in-creased when the tissues were treated with ADM (10~(-8) mol·L~(-1)) and PAMP (10~(-8) mol·L~(-1)) or ADT (10~(-8) mol·L~(-1)) in combination, compared with that after the treatment with ADM(10~(-8) mol·L~(-1))alone, but was significantly decreased than that in PAMP(10~(-8) mol·L~(-1)) or ADT(10~(-8)mol·L~(-1)) groups. After incubation with ADM,PAMP and ADT at the same dose (10~(-8) mol·L~(-1)), the content of cAMP did not change as compared with that of the ADM group (10~(-8) mol·L~(-1),P>0.05), but was greatly reduced, compared with that of the PAMP or ADT groups(10~(-8) mol·L~(-1),P<0.01).Conclusion ADM, PAMP and ADT which originate from the proadrenomedullin have an antagonism on cAMP production in rat aorta.
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Objective To investigate the effect of adrenomedullin(ADM) on hypoxic pulmonary vascular structural remodeling and proadrenomedullin N-terminal 20-peptide(PAMP) in rats with hypoxic pulmonary hypertension.Methods Twenty-four male Wistar rats were randomly divided into control group(n=8),hypoxia group(n=8) and hypoxia with ADM group(n=8).ADM was subcutaneously administered into rats of hypoxia with ADM group by mini-osmotic pump(300 ng/h).The concentration of plasma PAMP was measured by radioimmunoassay,and the expression of PAMP in pulmonary artery was detected by immunohistochemical assay.Results Mean pulmonary arterial pressure,the ratio of right ventricular mass to left ventricular plus septal mass,and relative medial thickness and relative medial area of pulmonary arteries significantly increased in hypoxic rats as compared with that of controls(P
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Objective To observe the changes of plasma urotensinⅡ(UⅡ)、PAMP(proadrenomedullin N-terminal peptide)and ANP(atrial natriuretic peptide)levels in patients with congestive heart failure (CHF) and to illustrate clinical significance of these changes.Methods 52 patients with CHF and 20 age and gender-matched control subjects were studied.Plasma UⅡ.PAMP and ANP levels of 52 patients with CHF and 20 control subjects were measured by radioimmunoassay.Heart function of all study subjects were mensurated by ultrasound cardiography.Results The plasma UⅡ levels were significantly lower in patients with CHF than that in control subjects [(1.48?1.05) vs (4.28?1.21) pg?mL -1,P
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0.05),but was greatly reduced,compared with that of the PAMP or ADT groups(10-8 mol?L-1,P
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Objectives To study the changes of plasma levels of proadrenomedullin N terminal peptide(PAMP) in patients with congestive heart faillure(CHF) before and after drug treatment and its significance.Methods Plasma PAMP levels in 45 patients with CHF and 7 heathy control subjects were measured by specific radioimmunoassy.Results The plasma PAMP levels in patients with CHF were significantly decreased with the deterioration of cardiac function.Plasma PAMP levels in 45 patients in NYHA class Ⅳ(2 79?0 89pg/mL) were significantly lower than those in class Ⅱ(6 24?1 71pg/mL)?class Ⅲ(7 38?1 28pg/mL) and control subjects(8 56?2 44pg/mL)(P
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Adrenomedullin is a vasodilative peptide found in 1993. It has been proved that proadrenomedullin can be divided into 4 peptides by endoenzyme. Proadrenomedullin N terminal 20 peptide (PAMP) is one of them. PAMP has many functions on cardiovascular physiology. But so far the relationship between PAMP and cardiovascular diseases has not been found. In this study its plasma levels in the patients with essential hypertension(EH) and heart failure(HF) were investigated with its pathophysiological effect discussed. The plasma levels of PAMP, endothilin(ET), Angiotension II(AT II) were measured with RIA, and norepinephrine(NE), epinephrine(E) were measured with HPLC. the plasma level of PAMP in the control group was 18 42?2 33ng/L, and was 1 62 times higher in EH group than in the control group, and was 1 53 times higher in HF group as compared with the control group respectively ( P