MR-proADM Kinetics and Disease Severity

The key mediator in sepsis

A rapid response to bacterial infection and disease severity

MR-proADM offers the fastest response to bacterial stimulation, and concentrations have been shown to increase in accordance with the severity of the condition. The earliest warning of infection after procedures such as surgery or trauma can be crucial in driving down hospital mortality, and providing optimal care at the earliest time point possible.

 

Extremely rapid response to LPS stimulation

In order to start prompt and appropriate treatment, it is crucial to make an accurate diagnosis and risk assessment as quickly as possible29. MR-proADM levels have been shown to be rapidly elevated immediately after the administration of LPS, reaching significantly increased levels after only 2 hours14, 30 and almost doubling in concentration30. Concentrations were found to subsequently peak at 4 hours14, 30 before decreasing. No increases in PCT, on the other hand, can be found up to 2 hours after LPS stimulation, with the earliest increases becoming apparent at 4 hours30, 31. In contrast to MR-proADM, peak PCT concentrations were subsequently observed at 24 hours30, 31.

Thus, the differing time courses for Adrenomedullin and PCT production may be of significant clinical interest, especially in post operative ICU patients, in order to determine the onset of infection at the earliest possible opportunity using MR-proADM, and subsequently guide antibiotic administration using PCT.

Significant increases in MR-proADM levelsSignificant increases in MR-proADM levels can be observed 2 hours after a single LPS injection (4ng/kg IV), as opposed to 4 hours in the case of PCT (adapted from de Kruif et al. 2008)30.

 

Increasing MR-proADM levels correlate to disease severity

In critically ill patients at admission, studies have shown there to be a stepwise increase in MR-proADM levels, from patients without infection (SIRS) to patients with sepsis, severe sepsis and septic shock32. Furthermore, a clear separation can be observed between SIRS and septic patients33.

evels of MR-proADM in critically ill patients on ICU admissionLevels of MR-proADM in critically ill patients on ICU admission, grouped according to the severity of disease. Non-infectious SIRS and sepsis are clearly distinguishable with MR-proADM levels significantly different.

 

 

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