Risk Assessment on the ICU

pct-mr-proadm

Risk assessment and prognosis upon admission

The ability to determine risk and prognosis, irrespective of the severity of sepsis, allows clinicians to make decisions as early as possible and tailor treatment accordingly. MR-proADM levels, when measured on admission, are significantly higher in non-survivors than survivors10, 14-16, thus allowing clinicians to make an immediate judgment on the risk and prognosis of the patient. In addition, AUC values of between 0.7716 and 0.8715, which are significantly higher than those of PCT or CRP10, confirm the exceptionally high prognostic capabilities of MR-proADM in septic patients on admission to the ICU.

Significant differences exist in MR-proADM valuesSignificant differences exist in MR-proADM values between survivors and non-survivors upon ICU admission in different clinical studies. Independent investigations grouped survivors and non-survivors as either a single sepsis, severe sepsis and septic shock cohort10, a severe sepsis and septic shock cohort16, or a sepsis and septic shock cohort14

 

Reduction assessment and prognosis over 7 days

 Unlike many other biomarkers, the prognostic value of MR-proADM as a predictor of mortality is not reduced after the initial onset of disease, but is maintained and even improved during the course of ICU stay16. Indeed, whilst MR-proADM levels in survivors decrease towards healthy levels during the first 7 days, consistently elevated levels are found in non-surviving patients irrespective of the degree of septic severity. Furthermore, increasing AUC values are also observed during the first 7 days of ICU admission. Values have been shown to increase from 0.77 on admission, to 0.88 after 7 days in a cohort of severe sepsis and septic shock patients16, as well as from 0.710 to 0.861 in septic shock patients9. In a study of only severe sepsis patients17, AUC values increase to 0.825 on the 5th day of ICU stay.

 

mr-proadm-auc-values-risk-survivorsMeasurements of MR-proADM in survivors and non-survivors at days 1-2 , 3-4 and 5-7 during the first week after septic shock9 (*P value < 0.05, **P value ≤ 0.01)

 

mr-proadm-auc-values-risk-levels2Decreasing MR-proADM levels in severe sepsis and septic shock survivors are significantly different to consistently elevated levels in non-survivors over the first 7 days after ICU admission. In addition, increasing AUC values indicate increased prognostic accuracy during ICU stay

 

thermo scientific applied biosystems invitrogen fisher scientific unity lab service