Adrenomedullin (ADM) is a peptide with pleiotropic effects in systemic inflammation. Its more stable precursor protein midregional proadrenomedullin (MRproADM) can be measured more reliably compared to ADM. Our objective was to investigate the potential role of MRproADM as a diagnostic and prognostic biomarker in critically ill patients at the intensive care unit (ICU). We therefore measured MRproADM in 203 ICU patients and 66 healthy controls. We found that MRproADM levels are significantly increased in critically ill patients as compared to healthy controls. MRproADM levels are significantly increased in patients with sepsis, but its diagnostic value for identifying sepsis is numerically lower than that of established markers (e.g., interleukin-6, C-reactive protein, and procalcitonin). MRproADM levels are closely correlated to endothelial and organ dysfunction, inflammation, and established clinical scores (APACHE II, SOFA, and SAPS2). MRproADM concentrations correlate with vasopressor use but not fluid balance. Increased MRproADM levels () in critically ill patients are independent predictors of ICU and overall mortality during a follow-up of up to 26 months (OR 3.15 for ICU mortality, 95% CI 1.08-9.20, ; OR for overall mortality 2.4, 95% CI 1.12-5.34, ). Our study demonstrates the potential of MRproADM serum levels as a prognostic biomarker in critical illness for ICU mortality and long-term survival during follow-up.

中文翻译：

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在两年的随访中，重症患者的中枢肾上腺髓质素（MRproADM）血清水平与短期和总体死亡率相关。

肾上腺髓质素（ADM）是一种在全身性炎症中具有多效作用的肽。与ADM相比，可以更可靠地测量其更稳定的前体蛋白中部区域肾上腺髓质素（MRproADM）。我们的目标是研究重症监护病房（ICU）中MRproADM作为重症患者诊断和预后生物标志物的潜在作用。因此，我们在203名ICU患者和66名健康对照者中测量了MRproADM。我们发现与健康对照组相比，危重患者的MRproADM水平显着增加。败血症患者的MRproADM水平显着增加，但其在识别败血症中的诊断价值在数值上低于已建立的标志物（例如白细胞介素6，C反应蛋白和降钙素）。MRproADM水平与内皮和器官功能障碍，炎症和已建立的临床评分（APACHE II，SOFA和SAPS2）密切相关。MRproADM的浓度与使用升压药有关，但与液体平衡无关。MRproADM水平升高（）在重症患者中，是长达26个月的随访中ICU和总死亡率的独立预测因素（ICU死亡率为OR 3.15，95％CI 1.08-9.20，; 或针对总死亡率2.4、95％CI 1.12-5.34，）。我们的研究证明了MRproADM血清水平作为ICU死亡率和随访期间长期生存的重症疾病预后生物标志物的潜力。