Emerging Role of Adrenomedullin as Sepsis Prognostic Marker

Abstract

Sepsis represents an important and global health problem. It affects 27–30 million people every year, 7–9 million of these die. Sepsis occurs when the body uncontrolled response to an infection injures its own tissues and organs. If it is not quickly recognised and treated, it may led to septic shock, multiorgan failure and death. Together with clinical signs, a series of biomarkers can be very useful in the early diagnosis of sepsis. Adrenomedullin (ADM) is one of these biomarkers, not only important for sepsis diagnosis but also particularly useful for prognosis. ADM is a hormone secreted by endothelial cells, involved in regulation of the endothelium barrier and vascular tone, so playing a decisive role in the inflammation process. The mid regional‐proadrenomedullin (MR‐proADM) is the molecule detected in septic patients because it is more stable than ADM and is released in an equimolar ratio of the active portion. MR‐proADM is capable to identify disease severity and progression, more accurately than other biomarkers and clinical scores. Inclusion of MR‐proADM assay in clinical routine could help the clinicians to manage septic patients especially by identifying their mortality risk.

Key Concepts

  • Sepsis is considered one of the most important public health concern with high rates of morbidity, mortality and resource consuming worldwide;
  • Sepsis is defined as uncontrolled immune response against infections;
  • A fast diagnosis of sepsis is necessary to promptly initiate the appropriate treatment;
  • Several biomarkers are adopted in clinical settings for sepsis diagnosis and prognosis, but the ‘gold standard’ has not found yet;
  • Mid Regional‐proAdrenomedullin (MR‐proADM) is a novel promising biomarker of prognosis associated to sepsis severity playing an important role in the initial evaluation and clinical management of septic patient.

Keywords: sepsis; biomarkers; clinical scores; mid regional pro‐adrenomedullin; prognosis

Figure 1. Structure of ADM gene located on chromosome 11: it is formed by four exons and three introns. The mRNA encodes proadrenomedullin: this one has four vasoactive peptides: ADM, aminoterminal peptide of proadrenomedullin (PAMP), adrenotensin and mid‐regional proadrenomedullin (MR‐proADM).
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Lia, Maria Stella, Angeletti, Silvia, Bernardini, Sergio, and Minieri, Marilena(Jan 2020) Emerging Role of Adrenomedullin as Sepsis Prognostic Marker. In: eLS. John Wiley & Sons Ltd, Chichester. http://www.els.net [doi: 10.1002/9780470015902.a0028883]