The diagnostic and prognostic value of mature and total adrenomedullin for sepsis: a prospective, observational study

Abstract Background: Biologically active adrenomedullin (mature AM) has received considerable attention as a new biomarker of sepsis and septic shock. However, information about this peptide is limited. In this study, we further investigated the value of mature AM for diagnosis and outcome prediction in sepsis.Methods: This was a prospective, observational, single-centre study. Patients admitted to the intensive care unit (ICU) were retrospectively categorised into non-sepsis or sepsis groups, according to the Sepsis-3 definitions. Plasma levels of mature and total (the sum of the levels of intermediate and mature forms) AM were measured, and their usefulness was compared with those of other sepsis biomarkers, such as procalcitonin and presepsin. Results: Of the 98 patients included in the final analysis, 42 were assigned to the non-sepsis and 56 to the sepsis group. Levels of mature and total AM on admission were significantly higher in patients with sepsis than in those without sepsis. The areas under the receiver operating characteristic curves of mature and total AM for predicting 28-day mortality in patients with sepsis became significant on day 3 after admission. A good correlation between the AM forms was found, indicating that the changes in their plasma levels may directly reflect each other.Conclusion: Because the levels of mature and total AM increased significantly in patients with sepsis on admission, both forms may be used as reliable and early biomarkers for diagnosing sepsis according to the Sepsis-3 definitions. However, prediction of 28-day mortality in such patients would require several days of ICU stay.