Correlation between plasma levels of adrenomedullin, severity of illness and outcome in critically ill patients

ABSTRACT

Adrenomedullin [AM] is a newly identified mutlifunctional endogenous peptide, widely distributed in human tissues. Recent studies demonstrate that AM has powerful and characteristically long lasting vasodepressor activity and it plays a role in the pathophysiology of inflammation and its levels Increase under stress conditions. The aim of this work was to evaluate plasma levels of adrenomedullin as a marker of severity of illness and outcome in critically ill patients. The plasma levels of AM were measured in 40 patients with various forms of systemic inflammatory response syndrome [SIRS] and 10 healthy volunteers serving as control. Plasma levels of AM in SIRS, severe trauma demonstrated 1826 +/- 10.64 Fmol/ml [Mean +/- SD], in traumatic shock, it was 76.20 +/- 45.04 Fmol/ml, in severe sepsis it was 70.10 +/- 40.8 Fmol/ml and in septic shock it was 273.0 +/- 232.84 FmoI/ml. These values were significantly higher than controls [5.81 +/- 1.15]. The patients with traumatic or septic shock especially had higher levels of plasma AM than those with trauma or severe sepsis respectively. These data showed that in patients with SIRS, plasma AM levels increased in proportion to the severity of illness. In this study, as well, there was a significant difference of plasma AM levels between survivors and non survivors in septic shock. The plama AM level might seive as a useful marker for evaluating the severity of disease and as an early predictor of outcome in septic shock