The predictive value of serum proadrenomedullin by dynamic monitoring in the prognosis of ventilator-associated pneumonia

NI Ju-ping; QU Hong-ping; SUN Ying-jie; SHEN Yun-le; ZHOU Ruo-wen; CAI Zhen-lin; LI Xiang

doi:10.3969/j.issn.1002-1949.2016.07.007

Abstract：Objective To evaluate the prognostic value of patients with ventilator-associated pneumonia by dynamic monitoring for serum proadrenomedullin(pro-ADM)levels. Methods A pro?spective observational cohort study including consecutive patients with VAP was conducted. According to the survival situation within the 28 days of ICU, the patients were divided into death group and surviv?al group. The levels of serum pro-ADM were measured by sandwich ELISA on 1st, 3rd and 5th days. The prognostic value of pro-ADM in VAP was assessed by receiver operating characteristic (ROC) curve. Results The serum pro-ADM level of the patients in the death group on 1st day[(4.18±1.78) nmol/L], 3rd day[(4.51 ± 1.88)nmol/L]and 5th day[(5.15 ± 1.89)nmol/L]were significantly higher than those in the survival group[(3.19±1.39)nmol/L,(2.98±1.35)nmol/L and(1.65±0.88)nmol/L, re?spectively](all P<0. 05). The serum pro-ADM level of the patients in the death group showed a trend of increase(P<0.001), while the survival group declined(P<0.001). For prognosis of VAP, the areas under the curve for pro-ADM on 1st, 3rd and 5th days were 0.664(95%CI 0.520~0.789), 0.746(95%CI 0.606~0.856)and 0.966(95%CI 0.874~0.997), respectively. When the cutoff value of pro-ADM was set above 3.13 nmol/L on the 5th day, the sensitivity and the specificity for predicting the prognostic value of patients with VAP were 86.7%and 94.6%. Conclusion Serum level of pro-ADM may be used as a marker to predict the prognostic value of patients with VAP early. The increased pro-ADM indicates a poor prognosis of VAP.