Midregional proadrenomedullin plasma concentration in emergency patients with dyspnea due to respiratory disease: a pilot study

Herrero Puente P

Background and objective: Adrenomedullin (ADM) is a prognostic biomarker that has

proven useful in various diseases, particularly infections. The midregional proADM (MRproADM)

plasma concentration reflects the ADM level and is a more stable measure.

This study aimed to explore the relationship between MR-proADM and severity of

disease in patients with dyspnea due to respiratory disease.

Patients and methods: Prospective, observational (no intervention), analytical pilot

study in hospital emergency department patients with shortness of breath caused by

respiratory disease. We recorded sociodemographic data, priority according to the

Manchester triage system (MTS), and clinical data (including laboratory findings)

collected in the emergency department. A plasma sample was reserved for later

determination of MR-proADM concentration. The patients were followed for 7 days after

the emergency department visit in order to record the discharge diagnosis, readmission,

or exitus. The assigned MTS priority level was used as a measure of severity.

Results: Fifty patients with a mean (SD) age of 69 (22) years were studied; 52% were

men. Twenty-eight patients (56%) were admitted and 17 (34%) were assigned an MTS

priority level of 2. The initial clinical picture indicated greater severity of disease in

admitted patients than in discharged patients; the number of variables studied did not

differ between patients assigned a priority level of 2 and those assigned a level of 3 or 4.

MR-proADM plasma concentrations were higher in admitted patients (1.19 [0.48]

nmol/L vs 0.75 [0.36] nmol/L in discharged patients; P=.001) and in patients assigned a

priority level of 2 (1.27 [0.56] nmol/L vs 0.87 [0.37] nmol/L in those assigned lower

priority; P=.004). When we controlled for the influence of age over 70 years, we found it

to be a confounding factor that led to changes of more than 20% in the odds ratio.

Conclusion: Given that this was a small pilot study, the results must be interpreted

cautiously. We detected a relationship between MR-proADM plasma concentration and

severity of respiratory disease, with age proving to be a confounding factor.

Herrero Puente P