AIMS Recently, bio-adrenomedullin (bio-ADM) was proposed as a congestion marker in heart failure (HF). In the present study, we aimed to study whether bio-ADM levels at discharge from a hospital admission for worsening HF could provide additional information on (residual) congestion status, diuretic dose titration and clinical outcomes. METHODS AND RESULTS Plasma bio-ADM was measured in 1236 acute HF patients in the PROTECT trial at day 7 or discharge. Median discharge bio-ADM was 33.7 [21.5-61.5] pg/mL. Patients with higher discharge bio-ADM levels were hospitalised longer, had higher brain natriuretic peptide levels, and poorer diuretic response (all P < 0.001). Bio-ADM was the strongest predictor of discharge residual congestion (clinical congestion score > 3) (odds ratio 4.35, 95% confidence interval 3.37-5.62; P < 0.001). Oedema at discharge was one of the strongest predictors of discharge bio-ADM (β = 0.218; P < 0.001). Higher discharge loop diuretic doses were associated with a poorer diuretic response during hospitalisation (β = 0.187; P < 0.001) and higher bio-ADM levels (β = 0.084; P = 0.020). High discharge bio-ADM levels combined with higher use of loop diuretics were independently associated with a greater risk of 60-day HF rehospitalisation (hazard ratio 4.02, 95% confidence interval 2.23-7.26; P < 0.001). CONCLUSION In hospitalised HF patients, elevated pre-discharge bio-ADM levels were associated with higher discharge loop diuretic doses and reflected residual congestion. Patients with combined higher bio-ADM levels and higher loop diuretic use at discharge had an increased risk of rehospitalisation. Assessment of discharge bio-ADM levels may be a readily applicable marker to identify patients with residual congestion at higher risk of early hospital readmission.

中文翻译：

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出院前生物肾上腺髓质素作为残余充血和心力衰竭高风险再次入院的标志物的临床价值。

目的最近，有人提出了生物肾上腺髓质素（bio-ADM）作为心力衰竭（HF）的一种充血指标。在本研究中，我们旨在研究因入院而导致HF恶化的生物ADM水平是否可以提供有关（残余）充血状态，利尿剂量滴定和临床结果的更多信息。方法和结果在PROTECT试验的第7天或出院时，对1236例急性HF患者进行了血浆bio-ADM测定。排出生物ADM的中位数为33.7 [21.5-61.5] pg / mL。出院生物ADM水平较高的患者住院时间更长，脑钠肽水平较高，并且利尿反应较差（所有P <0.001）。Bio-ADM是放电残留充血（临床充血评分> 3）的最强预测指标（赔率比4.35，95％置信区间3.37-5.62； P <0.001）。出院时水肿是出院生物ADM的最强预测指标之一（β= 0.218； P <0.001）。较高的排出环路利尿剂剂量与住院期间较差的利尿反应有关（β= 0.187； P <0.001）和较高的生物ADM水平（β= 0.084； P = 0.020）。较高的生物ADM排放水平和使用loop利尿剂的增加与60天HF再次住院的更大风险独立相关（危险比4.02，95％置信区间2.23-7.26； P <0.001）。结论在住院HF患者中，出院前生物ADM水平升高与更高的出院ure利尿剂剂量有关，并反映出残留的充血。出院时合并使用较高的生物ADM水平和使用较高的loop利尿剂的患者再次住院的风险增加。