Prognostic accuracy of mid-regional proadrenomedullin in patients with sepsis – A longitudinal observational study

Background: Prognostication in sepsis remains challenging as conventional scores and biomarkers, including procalcitonin (PCT) and lactate, show limited predictive strength when used alone. This study evaluated the ability of mid-regional proadrenomedullin (MR-proADM) to predict 14-day mortality in patients with sepsis, intending to improve early risk stratification. Methods: A prospective observational study was conducted at a tertiary hospital in North India over 18 months. One hundred and twenty patients admitted to the intensive care unit (ICU) and ward with sepsis were enrolled. On admission, serum MR-proADM, PCT, and lactate were measured, and Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were calculated. Prognostic accuracy was determined using the receiver operating characteristic (ROC) analysis. Results: The mean age of the participants was 45.9 ± 16.1 years, with 54.2% male. Nonsurvivors ( n = 56) required ICU care more frequently (69.6%) and ventilator support (55.4%). MR-proADM levels were significantly higher in nonsurvivors (2.48 ± 1.93 nmol/L) than survivors (1.43 ± 0.78 nmol/L, P 5.75 nmol/L was uniformly associated with mortality. Conclusion: MR-proADM is a reliable adjunctive prognostic biomarker for sepsis and may enhance early risk stratification when used alongside established scores and biomarkers.