Plasma Mid-Regional Pro-adrenomedullin as a Prognostic Biomarker in Hematopoietic Stem Cell Transplant Recipients with Febrile Neutropenia

This study aimed to elucidate the association between mid-regional pro-adrenomedullin (MR-proADM) levels at the onset of febrile neutropenia (FN) and clinical outcomes in patients with hematological malignancy undergoing hematopoietic stem cell transplantation (HSCT), and the prognostic performance of MR-proADM compared with established infection-related biomarkers comprising presepsin (P-SEP), procalcitonin (PCT), and C-reactive protein (CRP). We analyzed 26 patients (28 FN episodes) who underwent HSCT for hematological malignancy at Oita University Hospital. For each patient, time-dependent profiles of MR-proADM, P-SEP, PCT, and CRP from FN onset until clinical stabilization were evaluated. Correlation analysis was conducted among the four biomarkers. Multivariate analyses were performed to examine associations between peak biomarker levels and clinical outcomes. MR-proADM exhibited an early increase after FN onset, similar to other biomarkers. However, correlation analyses revealed no significant association between MR-proADM and P-SEP (rs = 0.087, p = 0.290), PCT (rs = 0.026, p = 0.791), or CRP (rs = 0.073, p = 0.332). Multivariate analysis identified MR-proADM (p = 0.049) as a significant predictor of fever duration, while CRP (p = 0.032) was significantly associated with the number of organs affected by acute graft-versus-host disease (aGVHD). This study is the first to evaluate MR-proADM at FN onset in HSCT recipients. Elevated MR-proADM may predict prolonged fever, whereas CRP may reflect the severity of aGVHD. These findings suggest that these biomarkers may serve as complementary biomarkers for predicting different clinical outcomes.