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Midregional proadrenomedullin plasma concentration in emergency patients with dyspnea due to respiratory disease: a pilot study

Herrero Puente P

√Ārea de Urgencias, Grupo de Investigaci√≥n en Urgencias y Emergencias, Servicio de Bioqu√≠mica Cl√≠nica, √Ārea de Gesti√≥n Cl√≠nica del Laboratorio de Medicina, Servicio de Atenci√≥n Medica Urgente (SAMU), Hospital Universitario Central de Asturias, Oviedo, Spain.

Background and objective: Adrenomedullin (ADM) is a prognostic biomarker that has
proven useful in various diseases, particularly infections. The midregional proADM (MRproADM)
plasma concentration reflects the ADM level and is a more stable measure.
This study aimed to explore the relationship between MR-proADM and severity of
disease in patients with dyspnea due to respiratory disease.
Patients and methods: Prospective, observational (no intervention), analytical pilot
study in hospital emergency department patients with shortness of breath caused by
respiratory disease. We recorded sociodemographic data, priority according to the
Manchester triage system (MTS), and clinical data (including laboratory findings)
collected in the emergency department. A plasma sample was reserved for later
determination of MR-proADM concentration. The patients were followed for 7 days after
the emergency department visit in order to record the discharge diagnosis, readmission,
or exitus. The assigned MTS priority level was used as a measure of severity.
Results: Fifty patients with a mean (SD) age of 69 (22) years were studied; 52% were
men. Twenty-eight patients (56%) were admitted and 17 (34%) were assigned an MTS
priority level of 2. The initial clinical picture indicated greater severity of disease in
admitted patients than in discharged patients; the number of variables studied did not
differ between patients assigned a priority level of 2 and those assigned a level of 3 or 4.
MR-proADM plasma concentrations were higher in admitted patients (1.19 [0.48]
nmol/L vs 0.75 [0.36] nmol/L in discharged patients; P=.001) and in patients assigned a
priority level of 2 (1.27 [0.56] nmol/L vs 0.87 [0.37] nmol/L in those assigned lower
priority; P=.004). When we controlled for the influence of age over 70 years, we found it
to be a confounding factor that led to changes of more than 20% in the odds ratio.
Conclusion: Given that this was a small pilot study, the results must be interpreted
cautiously. We detected a relationship between MR-proADM plasma concentration and
severity of respiratory disease, with age proving to be a confounding factor.

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