Plasma bioactive adrenomedullin on intensive care unit admission is associated with acute respiratory distress syndrome: an observational study
Abstract Background Bioactive adrenomedullin (bio-ADM) is a vasoactive peptide with a key role in reducing vascular hyperpermeability and improving endothelial stability during infection, but it also has vasodilatory properties. Bioactive ADM has not been studied in conjunction with acute respirator...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2023-03-01
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| Series: | Intensive Care Medicine Experimental |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40635-023-00494-7 |
| _version_ | 1797865839985164288 |
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| author | Patrik Johnsson Andrea Fredriksson Christer Tung Hans Friberg Attila Frigyesi |
| author_facet | Patrik Johnsson Andrea Fredriksson Christer Tung Hans Friberg Attila Frigyesi |
| author_sort | Patrik Johnsson |
| collection | DOAJ |
| description | Abstract Background Bioactive adrenomedullin (bio-ADM) is a vasoactive peptide with a key role in reducing vascular hyperpermeability and improving endothelial stability during infection, but it also has vasodilatory properties. Bioactive ADM has not been studied in conjunction with acute respiratory distress syndrome (ARDS), but it has recently been shown to correlate with outcomes after severe COVID-19. Therefore, this study investigated the association between circulating bio-ADM on intensive care unit (ICU) admission and ARDS. The secondary aim was the association between bio-ADM and ARDS mortality. Methods We analysed bio-ADM levels and assessed the presence of ARDS in adult patients admitted to two general intensive care units in southern Sweden. Medical records were manually screened for the ARDS Berlin criteria. The association between bio-ADM levels and ARDS and mortality in ARDS patients was analysed using logistic regression and receiver-operating characteristics analysis. The primary outcome was an ARDS diagnosis within 72 h of ICU admission, and the secondary outcome was 30-day mortality. Results Out of 1224 admissions, 11% (n = 132) developed ARDS within 72 h. We found that elevated admission bio-ADM level was associated with ARDS independently of sepsis status and of organ dysfunction as measured by the Sequential organ failure assessment (SOFA) score. Both lower levels (< 38 pg/L) and high (> 90 pg/L) levels of bio-ADM were independently (of the Simplified acute physiology score, SAPS-3) predictive of mortality. Patients with indirect mechanisms of lung injury had higher bio-ADM levels than those with a direct mechanism of injury, and bio-ADM increased with increasing ARDS severity. Conclusions High levels of bio-ADM on admission are associated with ARDS, and bio-ADM levels significantly differ depending on the injury mechanism. In contrast, both high and low levels of bio-ADM are associated with mortality, possibly due to the dual action of bio-ADM in stabilising the endothelial barrier and causing vasodilation. These findings could lead to improved diagnostic accuracy of ARDS and potentially lead to new therapeutic strategies. |
| first_indexed | 2024-04-09T23:15:29Z |
| format | Article |
| id | doaj.art-8e9223dfc6974d0d9451172f83639d28 |
| institution | Directory Open Access Journal |
| issn | 2197-425X |
| language | English |
| last_indexed | 2024-04-09T23:15:29Z |
| publishDate | 2023-03-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Intensive Care Medicine Experimental |
| spelling | doaj.art-8e9223dfc6974d0d9451172f83639d282023-03-22T10:03:45ZengSpringerOpenIntensive Care Medicine Experimental2197-425X2023-03-0111111510.1186/s40635-023-00494-7Plasma bioactive adrenomedullin on intensive care unit admission is associated with acute respiratory distress syndrome: an observational studyPatrik Johnsson0Andrea Fredriksson1Christer Tung2Hans Friberg3Attila Frigyesi4Department of Clinical Medicine, Anaesthesiology and Intensive Care, Lund UniversityDepartment of Clinical Medicine, Anaesthesiology and Intensive Care, Lund UniversityDepartment of Clinical Medicine, Anaesthesiology and Intensive Care, Lund UniversityDepartment of Clinical Medicine, Anaesthesiology and Intensive Care, Lund UniversityDepartment of Clinical Medicine, Anaesthesiology and Intensive Care, Lund UniversityAbstract Background Bioactive adrenomedullin (bio-ADM) is a vasoactive peptide with a key role in reducing vascular hyperpermeability and improving endothelial stability during infection, but it also has vasodilatory properties. Bioactive ADM has not been studied in conjunction with acute respiratory distress syndrome (ARDS), but it has recently been shown to correlate with outcomes after severe COVID-19. Therefore, this study investigated the association between circulating bio-ADM on intensive care unit (ICU) admission and ARDS. The secondary aim was the association between bio-ADM and ARDS mortality. Methods We analysed bio-ADM levels and assessed the presence of ARDS in adult patients admitted to two general intensive care units in southern Sweden. Medical records were manually screened for the ARDS Berlin criteria. The association between bio-ADM levels and ARDS and mortality in ARDS patients was analysed using logistic regression and receiver-operating characteristics analysis. The primary outcome was an ARDS diagnosis within 72 h of ICU admission, and the secondary outcome was 30-day mortality. Results Out of 1224 admissions, 11% (n = 132) developed ARDS within 72 h. We found that elevated admission bio-ADM level was associated with ARDS independently of sepsis status and of organ dysfunction as measured by the Sequential organ failure assessment (SOFA) score. Both lower levels (< 38 pg/L) and high (> 90 pg/L) levels of bio-ADM were independently (of the Simplified acute physiology score, SAPS-3) predictive of mortality. Patients with indirect mechanisms of lung injury had higher bio-ADM levels than those with a direct mechanism of injury, and bio-ADM increased with increasing ARDS severity. Conclusions High levels of bio-ADM on admission are associated with ARDS, and bio-ADM levels significantly differ depending on the injury mechanism. In contrast, both high and low levels of bio-ADM are associated with mortality, possibly due to the dual action of bio-ADM in stabilising the endothelial barrier and causing vasodilation. These findings could lead to improved diagnostic accuracy of ARDS and potentially lead to new therapeutic strategies.https://doi.org/10.1186/s40635-023-00494-7Adult respiratory distress syndromeBiomarkerAdrenomedullinEndothelial functionCOVID-19Sepsis |
| spellingShingle | Patrik Johnsson Andrea Fredriksson Christer Tung Hans Friberg Attila Frigyesi Plasma bioactive adrenomedullin on intensive care unit admission is associated with acute respiratory distress syndrome: an observational study Intensive Care Medicine Experimental Adult respiratory distress syndrome Biomarker Adrenomedullin Endothelial function COVID-19 Sepsis |
| title | Plasma bioactive adrenomedullin on intensive care unit admission is associated with acute respiratory distress syndrome: an observational study |
| title_full | Plasma bioactive adrenomedullin on intensive care unit admission is associated with acute respiratory distress syndrome: an observational study |
| title_fullStr | Plasma bioactive adrenomedullin on intensive care unit admission is associated with acute respiratory distress syndrome: an observational study |
| title_full_unstemmed | Plasma bioactive adrenomedullin on intensive care unit admission is associated with acute respiratory distress syndrome: an observational study |
| title_short | Plasma bioactive adrenomedullin on intensive care unit admission is associated with acute respiratory distress syndrome: an observational study |
| title_sort | plasma bioactive adrenomedullin on intensive care unit admission is associated with acute respiratory distress syndrome an observational study |
| topic | Adult respiratory distress syndrome Biomarker Adrenomedullin Endothelial function COVID-19 Sepsis |
| url | https://doi.org/10.1186/s40635-023-00494-7 |
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