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

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Tolppanen, H, Rivas-Lasarte, M, Lassus, J, Sans-Roselló, J, Hartmann, O, Lindholm, M, Arrigo, M, Tarvasmäki, T, Köber, 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, no. 1, pp. e6. https://doi.org/10.1186/s13613-016-0229-2

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Tolppanen H, Rivas-Lasarte M, Lassus J, Sans-Roselló J, Hartmann O, Lindholm M, Arrigo M, Tarvasmäki T, Köber 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. 7(1):e6. https://doi.org/10.1186/s13613-016-0229-2

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Tolppanen, Heli ; Rivas-Lasarte, Mercedes ; Lassus, Johan ; Sans-Roselló, Jordi ; Hartmann, Oliver ; Lindholm, Matias ; Arrigo, Mattia ; Tarvasmäki, Tuukka ; Köber, Lars ; Thiele, Holger ; Pulkki, Kari ; Spinar, Jindrich ; Parissis, John ; Banaszewski, Marek ; Silva-Cardoso, Jose ; Carubelli, Valentina ; Sionis, Alessandro ; Harjola, Veli-Pekka ; Mebazaa, Alexandre. / Adrenomedullin : a marker of impaired hemodynamics, organ dysfunction, and poor prognosis in cardiogenic shock. In: Annals of Intensive Care. 2017 ; Vol. 7, No. 1. pp. e6.

Bibtex

@article{b527c4cfa4544497bacd4482af308e8e,
title = "Adrenomedullin: a marker of impaired hemodynamics, organ dysfunction, and poor prognosis in cardiogenic shock",
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 (≤2 mmol/L) in most patients regardless of later outcome with lower prognostic value. By contrast, bio-ADM showed increasing prognostic value from 48 h and beyond (AUC 0.71 at 48 h and 0.80 at 5-10 days). Serial measurements of either bio-ADM or lactate were independent of and provided added value to CardShock risk score (P < 0.001 for both). Ninety-day mortality was more than double higher in patients with high levels of bio-ADM (>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. Study identifier of CardShock study NCT01374867 at clinicaltrials.gov.",
keywords = "Journal Article",
author = "Heli Tolppanen and Mercedes Rivas-Lasarte and Johan Lassus and Jordi Sans-Rosell{\'o} and Oliver Hartmann and Matias Lindholm and Mattia Arrigo and Tuukka Tarvasm{\"a}ki and Lars K{\"o}ber and Holger Thiele and Kari Pulkki and Jindrich Spinar and John Parissis and Marek Banaszewski and Jose Silva-Cardoso and Valentina Carubelli and Alessandro Sionis and Veli-Pekka Harjola and Alexandre Mebazaa",
year = "2017",
month = "12",
doi = "10.1186/s13613-016-0229-2",
language = "English",
volume = "7",
pages = "e6",
journal = "Journal of Intensive Care",
issn = "2110-5820",
publisher = "SpringerOpen",
number = "1",

}

RIS

TY - JOUR

T1 - Adrenomedullin

T2 - a marker of impaired hemodynamics, organ dysfunction, and poor prognosis in cardiogenic shock

AU - Tolppanen, Heli

AU - Rivas-Lasarte, Mercedes

AU - Lassus, Johan

AU - Sans-Roselló, Jordi

AU - Hartmann, Oliver

AU - Lindholm, Matias

AU - Arrigo, Mattia

AU - Tarvasmäki, Tuukka

AU - Köber, Lars

AU - Thiele, Holger

AU - Pulkki, Kari

AU - Spinar, Jindrich

AU - Parissis, John

AU - Banaszewski, Marek

AU - Silva-Cardoso, Jose

AU - Carubelli, Valentina

AU - Sionis, Alessandro

AU - Harjola, Veli-Pekka

AU - Mebazaa, Alexandre

PY - 2017/12

Y1 - 2017/12

N2 - 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 (≤2 mmol/L) in most patients regardless of later outcome with lower prognostic value. By contrast, bio-ADM showed increasing prognostic value from 48 h and beyond (AUC 0.71 at 48 h and 0.80 at 5-10 days). Serial measurements of either bio-ADM or lactate were independent of and provided added value to CardShock risk score (P < 0.001 for both). Ninety-day mortality was more than double higher in patients with high levels of bio-ADM (>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. Study identifier of CardShock study NCT01374867 at clinicaltrials.gov.

AB - 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 (≤2 mmol/L) in most patients regardless of later outcome with lower prognostic value. By contrast, bio-ADM showed increasing prognostic value from 48 h and beyond (AUC 0.71 at 48 h and 0.80 at 5-10 days). Serial measurements of either bio-ADM or lactate were independent of and provided added value to CardShock risk score (P < 0.001 for both). Ninety-day mortality was more than double higher in patients with high levels of bio-ADM (>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. Study identifier of CardShock study NCT01374867 at clinicaltrials.gov.

KW - Journal Article

U2 - 10.1186/s13613-016-0229-2

DO - 10.1186/s13613-016-0229-2

M3 - Journal article

VL - 7

SP - e6

JO - Journal of Intensive Care

JF - Journal of Intensive Care

SN - 2110-5820

IS - 1

ER -

ID: 52051325