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Midregion pro-adrenomedullin predicted mortality rate in acute HF patients

Maisel A. J Am Coll Cardiol. 2011;58:1057-1067.

Issue: October 2011

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Compared with other biomarkers, midregion pro-adrenomedullin was superior in predicting 90-day all-cause mortality in patients presenting with acute shortness of breath, according to a study.

Midregion pro-adrenomedullin (MR-proADM) was evaluated against other biomarkers in 1,641 patients who presented dyspnea as their primary symptom upon presentation to the ED. Blood samples were collected in plastic tubes containing ethylenediaminetetraacetic acid. The adjudicated diagnosis was acute HF in 34.6% of patients, chronic obstructive pulmonary disease in 12.2%, asthma in 7%, pneumonia in 6.8%, chest pain of unknown origin in 6.5%, bronchitis in 3.7%, arrhythmia in 3.4%, acute coronary syndromes in 2.4%, pulmonary embolism in 2.3%, influenza in 1.6% and “other” diseases as a primary diagnosis in 18.5%.

When set against other biomarkers, MR-proADM provided superior and independent prognostic information in patients with or without HF, according to the study. All-cause mortality at 90 days was best predicted in MR-proADM, followed by copeptin, N-terminal pro–B-type natriuretic peptide, midregion pro-atrial natriuretic peptide, B-type natriuretic peptide, procalcitonin, and troponin T or troponin I in patients with acute HF. MR-proADM also best predicted all-cause 90-day mortality in patients without acute HF.

Among patients with acute HF, there were 130 deaths within 90 days and 65 deaths within 90 days in patients without acute HF. According to researchers, patients with acute HF who died were older, more likely to be white, had lower BP, lower BMI, were more likely to be overtly volume overloaded and more likely to be on warfarin, diuretic agents, digoxin or aldosterone inhibitors. In patients without acute HF, 30% died of congestive HF, 7.7% of other cardiac diseases, 9.2% of chronic obstructive pulmonary disease, 5.4% of sepsis, 3.1% of respiratory tract infection and 44.6% of other reasons not further specified.

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