Adrenomedullin in sepsis

Abstract: AbstractBackgroundSepsis is a syndrome difficult to diagnose and stratify. The epidemiology of sepsis and consistency of criteria fulfillment with diagnosis coding in Swedish intensive care units (ICU) are largely unknown. Biomarkers can be of help to understand pathophysiology, identify clusters within sepsis and to individualize treatment.AimThe overarching aim of this thesis was to explore how adrenomedullin (ADM) relates, alone or in combination with other biomarkers, to sepsis in regard to mortality and illness severity among patients in the ICU and emergency department (ED). Due to the suspected underreporting of sepsis, and in order to relate admission ADM levels with sepsis definitions, the epidemiology of sepsis at ICU admission was described.MethodsThe cohorts included in this thesis, formed by sepsis and non-sepsis patients admitted to the ICU as well as sepsis patient in the ED, had their levels of ADM and other biomarkers measured and related to mortality, organ failure, need for organ support, and, when possible, to ICU admission and ED discharge.ResultsThe levels of ADM, endothelin-1 (ET-1) and high-sensitivity troponin t (hsTNT) were described during the first 7 days of ICU admission in a septic shock cohort and showed a significant association with mortality and myocardial injury. A positive biomarker panel with all three biomarkers increased the odds for mortality 13 to 20-fold.Approximately one third of all ICU admissions fulfilled the sepsis-3 criteria, but the consistency with diagnosis coding was poor, as only 31% of these patients had sepsis as main diagnosis.Among sepsis and non-sepsis ICU patients alike, increasing levels of ADM were associated with mortality and need for organ support. After adjusting for severity of disease an association of ADM with sepsis was seen.ADM measured among ED sepsis patients showed significant association with mortality, severe organ failure, ICU admission and ED discharge. Further, ADM added information to other known demographic predictors and routine biomarkers.ConclusionsADM, alone or in combination with other biomarkers, adds information to known prognostic factors and seems to be of aid in triaging, stratification and prognostication of sepsis patients in the ED and ICU.