SERAFINO MANSUETO AWARD | The prognostic value of Mid-Regional-pro-adrenomedullin serum levels in predicting in-hospital death in patients with sepsis and septic shock

Background and Aims: Early diagnosis and severity of disease stratification using clinical gestalt, scoring systems and biohumoral markers is crucial in sepsis, since it prompts early treatment and accurate prognostication. This study aimed at evaluating the prognostic role of Mid-Regional-pro-adrenomedullin serum levels in patients with sepsis or septic shock. Methods: A prospective study was conducted in subjects with defined sepsis or septic shock admitted to the Intermediate Care Unit of Careggi Hospital, Firenze, between March and March 2024. A panel of predefined biohumoral markers, including Mid-Regional-proADM was obtained at 3 different time intervals. MR-proADM was evaluated in predicting in-hospital mortality. Results: 41 patients were enrolled in the study. The median age was 64, men (76%). In hospital mortality was (19%); the median Mid-Regional-proADM at baseline was higher in patients who died with respect to survivors (5,69 nmol/L vs di 1,45 nmol/L; p<0.001). ROC analysis showed that a cut-off value of 3 nmol/L had the best accuracy in predicting in-hospital mortality (AUC 0.873, 95% CI 0.768-0.978, p≤0.0001). A value of Mid-Regional-pro-ADM at baseline >3 nmol/L independently increased the risk of in-hospital death (OR 3.75, 95%CI 1.12-13.91; p<0.05). No difference was observed in subjects dying or surviving, analysing dynamic changes of MR-pro-ADM. Conclusions: This study highlights the prognostic value of MR-proADM at baseline in patients with sepsis and septic shock. Baseline Mid-Regional-proADM >3 nmol/L was accurate in predicting in-hospital mortality.