Key result
Elevated 6-hour MR-pro-adrenomedullin predicts hospital mortality better than APACHE IV, with ~69-fold higher odds.
Why the study?
Commonly used ICU prognostic models are vulnerable to varying data definitions and data collection errors, prompting evaluation of whether postoperative biomarkers could improve hospital mortality risk assessment compared with the Acute Physiology and Chronic Health Evaluation IV score.
Does postoperative MR-pro-adrenomedullin and a biomarker panel improve prediction of hospital mortality compared to the APACHE IV score in patients undergoing elective cardiac surgery?
Cohort (n=800)
No
Does postoperative MR-pro-adrenomedullin and a biomarker panel improve prediction of hospital mortality compared to the APACHE IV score in patients undergoing elective cardiac surgery?
In patients undergoing elective cardiac surgery, MR-pro-adrenomedullin measured 6 to 18 hours after ICU admission is a superior predictor of hospital mortality compared to the APACHE IV score.
Answers are grounded in this paper and cite their sources.
MR-pro-adrenomedullin may aid early mortality prediction after cardiac surgery; hypothesis-generating and should not yet change practice.
Objectives Risk assessment in ICU patients using commonly used prognostic models may be influenced using different data definitions and by errors in data collection. We investigated whether a set of biomarkers (procalcitonin, MR-pro-adrenomedullin, CT-pro-endothelin-1, CT-pro-arginine vasopressin, and MR-pro-atrial natriuretic peptide), alone or as a panel, could be useful in postoperative risk assessment for hospital mortality in comparison with the Acute Physiology and Chronic Health Evaluation IV score. Design In a prospective observational cohort study, we analyzed 800 consecutive patients undergoing elective cardiac surgery. We assessed biomarker levels on admission to the ICU and every 6 hours thereafter for 24 hours. For every postoperative time point and for every biomarker, we determined the predictive value for hospital mortality and made a comparison with the Acute Physiology and Chronic Health Evaluation IV score. Setting Intensive care of an academic referral hospital. Patients A total of 800 consecutive patients undergoing elective cardiac surgery. Interventions None. Measurements and main results MR-pro-adrenomedullin is a good predictor of mortality (c-statistic at time point 6 hr after admission to the ICU, 0.940; 95% CI, 0.918-0.956) and performed better than the Acute Physiology and Chronic Health Evaluation IV score (c-statistic, 0.842; 95% CI, 0.811-0.868). The c-statistic did not change significantly on the time points 6, 12, and 18 hours after admission. Using a cutoff value for proadrenomedullin taken 6 hours after admission on ICU (time point 2) of 3.2 nmol/L sensitivity was 81.8% and specificity 93.9%, the positive likelihood ratio was 13.3, positive predictive value was 31.0%, and negative predictive value was 99.4%. Patients with a MR-pro-adrenomedullin above this cutoff level had an odds ratio of 68.9 (95% CI, 22.2-213.1) for not surviving their hospital stay. The other biomarkers had less predictive power. Conclusions In elective cardiac surgery, MR-pro-adrenomedullin measured between 6 and 18 hours after admission to the ICU is a better predictor of hospital mortality in comparison with the Acute Physiology and Chronic Health Evaluation IV score.
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Schoe et al. (2015) conducted a cohort in Elective cardiac surgery (n=800). MR-pro-adrenomedullin (>3.2 nmol/L at 6 hours post-ICU admission) and biomarker panel vs. Acute Physiology and Chronic Health Evaluation IV (APACHE IV) score and MR-pro-adrenomedullin ≤3.2 nmol/L was evaluated on Hospital mortality (OR 68.9, 95% CI 22.2-213.1). MR-pro-adrenomedullin at 6h post-ICU admission better predicted hospital mortality than APACHE IV (c-statistic 0.940 vs 0.842; OR 68.9, 95% CI 22.2-213.1 for >3.2 nmol/L).
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