Association of perioperative bioactive adrenomedullin with early postoperative organ dysfunction after major hepatic resection: An exploratory observational study

PURPOSE: To explore the association between perioperative bioactive adrenomedullin (bioADM) and early postoperative organ dysfunction after major hepatic resection, using the Sequential Organ Failure Assessment (SOFA) score as a measure of organ dysfunction severity. METHODS: This prospective, observational single-center study included 17 patients undergoing major hepatic resection between January and June 2023. BioADM was measured preoperatively and on postoperative days (POD) 1, 2, 3, and 5. Associations with SOFA were assessed using Spearman's rank correlation. Secondary exploratory analyses evaluated organ-specific and overall postoperative outcomes. RESULTS: Perioperative bioADM was associated with postoperative organ dysfunction severity as reflected by SOFA. Correlations were weak at baseline and POD1 but became moderate to strong from POD2 onward, including POD2 (ρ = 0.74, p = 0.001), POD3 (ρ = 0.64, p = 0.012), and POD5 (ρ = 0.67, p = 0.008). Exploratory secondary analyses suggested associations with vasopressor requirement and renal deterioration, particularly dialysis requirement. In contrast, bioADM showed no consistent association with major complications, Clavien-Dindo grade, 30-day Comprehensive Complication Index, or 30-day mortality. CONCLUSION: In this small exploratory cohort (n = 17), perioperative bioADM was associated with early postoperative organ dysfunction after major hepatic resection, particularly from POD2 onward, but not with broader measures of postoperative morbidity or short-term mortality. Given the limited sample size and low number of events, these findings are hypothesis-generating and require validation in larger prospective cohorts before any conclusions regarding clinical utility can be drawn.