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01.12.2005 | Research | Ausgabe 6/2005 Open Access

Critical Care 6/2005

Mid-regional pro-adrenomedullin as a prognostic marker in sepsis: an observational study

Critical Care > Ausgabe 6/2005
Mirjam Christ-Crain, Nils G Morgenthaler, Joachim Struck, Stephan Harbarth, Andreas Bergmann, Beat Müller
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​cc3885) contains supplementary material, which is available to authorized users.

Competing interests

NGM, JS and AB are employees of B.R.A.H.M.S., the manufacturer of the proADM assay (Brahms Sevadil® LIA; B.R.A.H.M.S. AG, Hennigsdorf/Berlin, Germany).

Authors' contributions

BM conceived the study, collected the data, drafted the protocol and supervised the writing of the manuscript. MCC and NGM conducted the analyses and wrote the report. NGM, JS and AB were involved in assay development. SH conducted statistical analyses. All authors read and approved the final manuscript.



Measurement of biomarkers is a potential approach to early assessment and prediction of mortality in patients with sepsis. The aim of the present study was to evaluate the prognostic value of mid-regional pro-adrenomedullin (MR-proADM) levels in a cohort of medical intensive care patients and to compare it with other biomarkers and physiological scores.


We evaluated blood samples from 101 consecutive critically ill patients admitted to the intensive care unit and from 160 age-matched healthy control individuals. The patients had initially been enrolled in a prospective observational study investigating the prognostic value of endocrine dysfunction in critically ill patients ("PEDCRIP" Study). The prognostic value of MR-proADM levels was compared with those of two physiological scores and of various biomarkers (for example C-reactive Protein, IL-6, procalcitonin). MR-proADM was measured in EDTA plasma from all patients using a new sandwich immunoassay.


On admission, 53 patients had sepsis, severe sepsis, or septic shock, and 48 had systemic inflammatory response syndrome. Median MR-proADM levels on admission (nmol/l [range]) were 1.1 (0.3–3.7) in patients with systemic inflammatory response syndrome, 1.8 (0.4–5.8) in those with sepsis, 2.3 (1.0–17.6) in those with severe sepsis and 4.5 (0.9–21) in patients with septic shock. In healthy control individuals the median MR-proADM was 0.4 (0.21–0.97). On admission, circulating MR-proADM levels in patients with sepsis, severe sepsis, or septic shock were significantly higher in nonsurvivors (8.5 [0.8–21.0]; P < 0.001) than in survivors (1.7 [0.4–17.6]). In a receiver operating curve analysis of survival of patients with sepsis, the area under the curve (AUC) for MR-proADM was 0.81, which was similar to the AUCs for IL-6, Acute Physiology and Chronic Health Evaluation II score and Simplified Acute Physiology Score II. The prognostic value of MR-proADM was independent of the sepsis classification system used.


MR-proADM may be helpful in individual risk assessment in septic patients.
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