Adrenomedullin : a marker of impaired hemodynamics, organ dysfunction, and poor prognosis in cardiogenic shock

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http://hdl.handle.net/10138/195079

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Tolppanen , H , Rivas-Lasarte , M , Lassus , J , Sans-Rosello , J , Hartmann , O , Lindholm , M , Arrigo , M , Tarvasmäki , T , Kober , L , Thiele , H , Pulkki , K , Spinar , J , Parissis , J , Banaszewski , M , Silva-Cardoso , J , Carubelli , V , Sionis , A , Harjola , V-P & Mebazaa , A 2017 , ' Adrenomedullin : a marker of impaired hemodynamics, organ dysfunction, and poor prognosis in cardiogenic shock ' , Annals of intensive care , vol. 7 , 6 . https://doi.org/10.1186/s13613-016-0229-2

Title: Adrenomedullin : a marker of impaired hemodynamics, organ dysfunction, and poor prognosis in cardiogenic shock
Author: Tolppanen, Heli; Rivas-Lasarte, Mercedes; Lassus, Johan; Sans-Rosello, Jordi; Hartmann, Oliver; Lindholm, Matias; Arrigo, Mattia; Tarvasmäki, Tuukka; Kober, Lars; Thiele, Holger; Pulkki, Kari; Spinar, Jindrich; Parissis, John; Banaszewski, Marek; Silva-Cardoso, Jose; Carubelli, Valentina; Sionis, Alessandro; Harjola, Veli-Pekka; Mebazaa, Alexandre
Contributor: University of Helsinki, HUS Heart and Lung Center
University of Helsinki, HUS Heart and Lung Center
University of Helsinki, Clinicum
University of Helsinki, HUS Emergency Medicine and Services
Date: 2017-01-04
Language: eng
Number of pages: 10
Belongs to series: Annals of intensive care
ISSN: 2110-5820
URI: http://hdl.handle.net/10138/195079
Abstract: Background: The clinical CardShock risk score, including baseline lactate levels, was recently shown to facilitate risk stratification in patients with cardiogenic shock (CS). As based on baseline parameters, however, it may not reflect the change in mortality risk in response to initial therapies. Adrenomedullin is a prognostic biomarker in several cardiovascular diseases and was recently shown to associate with hemodynamic instability in patients with septic shock. The aim of our study was to evaluate the prognostic value and association with hemodynamic parameters of bioactive adrenomedullin (bio-ADM) in patients with CS. Methods: CardShock was a prospective, observational, European multinational cohort study of CS. In this sub-analysis, serial plasma bio-ADM and arterial blood lactate measurements were collected from 178 patients during the first 10 days after detection of CS. Results: Both bio-ADM and lactate were higher in 90-day non-survivors compared to survivors at all time points (P <0.05 for all). Lactate showed good prognostic value during the initial 24 h (AUC 0.78 at admission and 0.76 at 24 h). Subsequently, lactate returned normal ( 55.7 pg/mL) at 48 h compared to those with low bio-ADM levels (49.1 vs. 22.6%, P = 0.001). High levels of bio-ADM were associated with impaired cardiac index, mean arterial pressure, central venous pressure, and systolic pulmonary artery pressure during the study period. Furthermore, high levels of bio-ADM at 48 to 96 h were related to persistently impaired cardiac and end-organ function. Conclusions: Bio-ADM is a valuable prognosticator and marker of impaired hemodynamics in CS patients. High levels of bio-ADM may show shock refractoriness and developing end-organ dysfunction and thus help to guide therapeutic approach in patients with CS.
Subject: Adrenomedullin
Cardiogenic shock
Biomarkers
Lactate
Hemodynamics
Mortality
ACUTE MYOCARDIAL-INFARCTION
ACUTE HEART-FAILURE
MIDREGIONAL PRO-ADRENOMEDULLIN
MECHANICAL CIRCULATORY SUPPORT
SHORT-TERM MORTALITY
ACUTE DYSPNEA
RISK STRATIFICATION
EUROPEAN-SOCIETY
SEPTIC SHOCK
TASK-FORCE
3121 General medicine, internal medicine and other clinical medicine
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