Initial levels of mr-proadrenomedullin: a predictor of severity in patients with influenza a virus pneumonia

Abstract

Issue Title: ESICM LIVES 2015

Valenzuela Sanchez et al. Intensive Care Medicine Experimental 2015, 3(Suppl 1):A832 http://www.icm-experimental.com/content/3/S1/A832

POSTER PRESENTATION Open Access

Initial levels of mr-proadrenomedullin: a predictor of severity in patients with influenza a virus pneumonia

F Valenzuela Sanchez1*, B Valenzuela Mendez2, JF Rodrguez Gutierrez3, R Bohollo de Austria1, J Rubio Quiones4, L Puget Martnez5, I Valiente Alemn6, A Estella Garca1

From ESICM LIVES 2015Berlin, Germany. 3-7 October 2015

Introduction

High levels of MR-proadrenomedullin (MR-proADM) have been described in critical sepsis patients. This is directly related to the relaxation of vascular tone and, therefore, hypotension and the presence of organ failure in patients with septic shock. In patients with severe pneumonia due to influenza A, although without great hemodynamic compromise, the presence of respiratory failure worsens the prognosis and significantly increases mortality.

Objective

Evaluate the usefulness of MR-proADM comparing them to C-reactive protein (CRP) and procalcitonin (PCT) in the prognosis of patients with influenza A virus pneumonia.

Methods

Prospective observational multicenter study. We included patients admitted to the ICU of five hospitals

in Spain with the diagnosis of severe sepsis during a period of 36 months due to influenza A virus pneumonia. Biomarker levels (MR-proADM, CRP, PCT) were determined at admission. Data were compared with a control group (CG) of patients, also with influenza virus A pneumonia, but less severe who were not admitted to the ICU.

Results

66 patients were included: 41 patients with severe pneumonia caused by influenza A virus (IAvPN) and 25 patients were included in the control group (CG).The IAvPN group mortality was 29.26% (12/41). PCT levels were similar in both groups: 0.3 g/l (IQR 0.00-1.175) in the GC and 0,27g/l (IQR 0.155-0.700) in the IAvPN group. The levels of CRP at admission were 9.2 mg / dl (IQR 5.6-14,3) in IAvPN and 6.37 mg / dl (IQR2.5-10.93) in the CG (p = 0.112). The MR-proADM levels at admission were 1.40 nmol / l (IQR 0994-2374)

Figure 1 Initial CRP, PCT and MR-proADM levels.

1Hospital del SAS de Jerez, Critical Care Medicine, Jerez de la Frontera, Spain Full list of author information is available at the end of the article

2015 Valenzuela Sanchez et al.; This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0

Web End =http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Valenzuela Sanchez et al. Intensive Care Medicine Experimental 2015, 3(Suppl 1):A832 http://www.icm-experimental.com/content/3/S1/A832

Page 2 of 2

Table 1 multivariate analysis (Cox models)

Endpoint: 90-day mortality Covariate Hazard Ratio (95%CI)

Regression Coefficient

Standard error

p value

Multivariate analysis (Backward Method)

MR-proADM at admission

2.4931 (1.269-4.895) 0.9135 0.3460 p = 0.0083

Figure 2 MR-proADM ROC curve for prognostic severity.

Authors details

1Hospital del SAS de Jerez, Critical Care Medicine, Jerez de la Frontera, Spain.

2Hospital Universitari Germans Trias i Pujol, Ginecology and Obstetric Department, Barcelona, Spain. 3Hospital del SAS de Jerez, Hematology, Jerez de la Frontera, Spain. 4Hospital Puerta del Mar, Critical Care Medicine, Cadiz, Spain. 5Hospital Santa Mara del Puerto, Critical Care Medicine, El Puerto de Santa Mara, Spain. 6Hospital Universitario de Puerto Real, Critical Care Medicine, Puerto Real, Spain.

Published: 1 October 2015

doi:10.1186/2197-425X-3-S1-A832Cite this article as: Valenzuela Sanchez et al.: Initial levels of mrproadrenomedullin: a predictor of severity in patients withinfluenza a virus pneumonia. Intensive Care Medicine Experimental 2015 3 (Suppl 1):A832.

Figure 3 proADM ROC curve for prognostic mortality.

IAvPN against 0.5437 nmol / l (IQR from 0.404 to0.891) in the CG (p = 0.001) (Figure 1).

The area under the ROC curve (AUC) for prognostic

severity (ICU admission) was 0.6769 (p < 0.0961) for CRP levels, 0.5767 (p < 0.543) for PCT levels and0.87058 for MR-proADM levels (p < 0.0001). The optimal cutoff for severity (ICU admission) MR_proADM levels at admission was 1.09 nmol / l, with a sensitivity of 73.53% and a specificity of 96%.(Figure 2).

The non survivors showed greater MR-proADM levels with a median of 1.622 nmol / l (IQR 1.35-4.420) vs0.8606 nmol/l (IQR 0.459-1.382) in the survivors (p =0.0014). the PCT and CRP levels showed no significant difference in mortality groups. The AUC the ROC curve

for prognostic mortality was: MR-proADM 0.838 (p =0.0001); PCT 0.599 (p = 0.591) CRP 0.6400 (p = 0.0072) (Figure 3).

In the multivariate analysis (Cox proportional hazards models) only MR-proADM levels at admission, were statistically significant predictive factors for mortality in the ICU and at 90 days.(Table 1)

Conclusions

Initial MR-proADM levels are effective to determine the unfavorable outcome and the risk of ICU admission and mortality in patients with pneumonia due to influenza A virus.

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