Embedded Files
Poland (Polska)
Prognostic value of midregional proadrenomedullin in critically ill patients
Prediction in Medicine is everything. We search for predictive tools for diagnoses, therapeutic response, relapses, treatment failures, to name a few. And when the stakes are relatively high, such as that seen with critically ill patients, accurate prediction becomes paramount to utilize resources most effectively and set realistic expectations. The latter isn't new to either the World Cup or NephroWorldCup units for Poland. After eight (8) World Cup appearances and two (2) third-place finishes, The White Eagles know a thing or two about setting the right expectations for the resources available.
And so it is no surprise that Poland fields a strong NephroWorldCup team that looks at a relatively new mortality predictive tool in critically ill patients. For many, the Sequential Organ Failure Assessment (SOFA), Acute Physiologic and Chronic Health Evaluation II (APACHE II), and/or the Pneumonia Severity Index (PSI) scoring scales have been used to predict mortality in patients admitted to the ICU (Figure 1).
These schema require multiple lab values performed over a fixed period of time and are often limited to specific diagnoses. Researchers in Poland wanted a better prediction tool: easier to measure with favorable statistical power and more universally applicable to all types of critically ill patients.
Video 1: The use of MR-proADM | Courtesy of Thermo Fisher Scientific
The White Eagles hypothesized that the midregional proadrenomedullin (MR-proADM) molecule would be as good or better than two commonly used prediction tools: SOFA and APACHE II. Adrenomedullin is part of the calcitonin family of molecules and is released by a variety of cells/tissues during stress. Unfortunately, it is difficult to measure directly because of a short half-life (22 minutes) . The pro-molecule is a bit more stable; in particular its mid-region section. Thus the researchers' focus on the MR-proADM fragment as a measurable and potential predictive tool (Video 1).
Seventy-seven (77) critically ill patients were analyzed in this secondary analysis of a single-center prospective study (an observational study). SOFA and APACHE II scores, as well as a MR-proADM level were calculated to determine the robustness of the latter in mortality prediction. Patients who succumbed to their illness had a higher MR-proADM than those who survived: median 2592.5 [IQR: 1668.0-2998.0 pg/mL) versus 995.3 [IQR: 782.1-1256.0 pg/mL; p < 0.001). In fact, the receiver operator characteristic for MR-proADM was better than either SOFA or APACHE II (Figure 2).
Figure 2: Receiver operator characteristics of midregional proadrenomedullin, SOFA, and APACHE II scores
Equally impressive is the predictive power for ICU mortality. The researchers determined at the optimal threshold level for MR-proADM is 1616 pg/mL. At such a threshold, the sensitivity and specificity for predicting mortality is 85% and 96%, respectively (Figure 3).
Figure 3: Kaplan-Meier survival curve using a threshold MR-proADM level of 1616 pg/mL
Poland's entry into the NephroWorldCup is exciting and thought-provoking. They raise the possibility that a single blood test can have greater predictive power than two commonly used scoring schema. While our predictive powers is not nearly as accurate as those of the MR-proADM, we think this team will move forward in The Tournament.
Google Sites
Report abuse