The Diagnostic Value of Serum Proadrenomedullin in Ventilator-Associated Pneumonia_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

NiJuping ^1,2 ,  QuHongping ¹ , LiuJialin ¹ , HuangJie ¹ , SunJingyong ¹ , CaiZhenlin ² , LiXiang ²

1. Department of Critical Care Medicine, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, 200025, China;
2. ;

Corresponding?author：

QuHongping, Email: hongping_rj@163.com

Keywords：

Proadrenomedullin; Ventilator-associated pneumonia; Clinical pulmonary infection score; Procalcitonin; Diagnosis

DOI：

10.7507/1671-6205.2016005

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Objective To investigate the clinical value of serum proadrenomedullin (pro-ADM) for diagnosis of ventilator-associated pneumonia(VAP). Methods A prospective study was carried out in eighty-nine patients with clinically suspected diagnosis of VAP who underwent invasive mechanical ventilation between June 2014 and July 2015.The patients were divided into a VAP group (n=52) and a non-VAP group (n=37) according to clinical and microbiological culture results.The levels of serum pro-ADM were measured by sandwich ELISA on 1^st, 3^rd and 5^th day of VAP suspicion.The diagnostic value of pro-ADM for VAP was assessed by receiver operating characteristic (ROC) curve analysis. Results On 1^st day, 3^rd day and 5^th day, the pro-ADM levels [3.10(2.21, 4.61) nmol/L, 3.01(2.04, 4.75)nmol/L and 1.85(1.12, 3.54)nmol/L, respectively] in the VAP group were significantly higher than those in the non-VAP group [1.53(1.07, 2.24)nmol/L, 1.52(1.05, 2.17) nmol/L and 1.26(1.02, 2.17) nmol/L, respectively] (all P < 0.05).For diagnosis of VAP, the area under the ROC curve (AUC) for pro-ADM on 1^st, 3^rd and 5^th were 0.896 (95%CI 0.799-0.940), 0.863(95%CI 0.791-0.935) and 0.651 (95%CI 0.538-0.765), respectively.When using 2.53 nmol/L as the best cutoff on 1^st day, pro-ADM had 84.6% sensitivity and 86.5% specificity.When using 2.40 nmol/L as the best cutoff on 3^rd day, pro-ADM had 82.7% sensitivity and 83.8% specificity. Conclusion Serum level of pro-ADM in the diagnosis of VAP has good sensitivity and specificity, which may be used as a marker to diagnose VAP early.

Citation： NiJuping, QuHongping, LiuJialin, HuangJie, SunJingyong, CaiZhenlin, LiXiang. The Diagnostic Value of Serum Proadrenomedullin in Ventilator-Associated Pneumonia. Chinese Journal of Respiratory and Critical Care Medicine, 2016, 15(1): 17-21. doi: 10.7507/1671-6205.2016005 Copy

1.	Guignant C, Voirin N, Venet F, et al. Persistent high level of circulating midregional-proadrenomedullin and increased risk of nosocomial infections after septic shock. J Trauma Acute Care Surg, 2012, 72:293-296.
2.	中華醫學會重癥醫學分會.呼吸機相關性肺炎診斷、預防和治療指南(2013).中華內科雜志, 2013, 52:524-543.
3.	Safdar N, Dezfulian C, Collard HR, et al. Clinical and economic consequences of ventilator-associated pneumonia:a systematic review. Crit Care Med, 2005, 33:2184-2193.
4.	Cheng CW, Chien MH, Su SC, et al. New markers in pneumonia. Clin Chim Acta, 2013, 419:19-25.
5.	Linssen CF, Bekers O, Drent M, et al. C-reactive protein and procalcitonin concentrations in bronchoalveolar lavage fluid as a predictor of ventilator-associated pneumonia. Ann Clin Biochem, 2008, 45:293-298.
6.	尹輝明, 楊宏亮, 劉繼民, 等.監測降鈣素原與感染細胞在呼吸機相關性肺炎的早期診斷價值.中國呼吸與危重監護雜志, 2012, 12:454-456.
7.	Zielinska-Borkowska U, Skirecki T, Zlotorowicz M, et al. Procalcitonin in early onset ventilator-associated pneumonia. J Hosp Infect, 2012, 81:92-97.
8.	Linscheid P, Seboek D, Zulewski H, et al. Autocrine/paracrine role of inflammation-mediated calcitonin gene-related peptide and adrenomedullin expression in human adipose tissue. Endocrinology, 2005, 146:2699-2708.
9.	Miguel D, Prieto B, Costa M, et al. Cord blood plasma reference intervals for potential sepsis markers:pro-adrenomedullin, pro-endothelin, and pro-atrial natriuretic peptide. Clin Biochem, 2011, 44:337-341.
10.	Debiane L, Hachem RY, Al Wohoush I, et al. The utility of proadrenomedullin and procalcitonin in comparison to C-reactive protein as predictors of sepsis and bloodstream infections in critically ill patients with cancer. Crit Care Med, 2014, 42:2500-2507.
11.	Ruiz-Gonzalez A, Esquerda A, Porcel JM, et al. A pilot study on the diagnostic accuracy of proadrenomedullin and proatrial natriuretic peptide in lower respiratory tract infections. Open Respir Med J, 2014, 8:22-27.
12.	夏慶, 曹云, 楊毅, 等.血漿腎上腺髓質素前體在新生兒感染中的變化及其意義.中華圍產醫學雜志, 2010, 13:29-31.
13.	Alcoba G, Manzano S, Lacroix L, et al. Proadrenomedullin and copeptin in pediatric pneumonia:a prospective diagnostic accuracy study. BMC Infect Dis, 2015, 15:347-350.
14.	Florkowski CM. Sensitivity, specificity, receiver-operating characteristic (ROC) curves and likelihood ratios:communicating the performance of diagnostic tests. Clin Biochem Rev, 2008, 29:S83-87.
15.	Zudaire E, Portal-Nunez S, Cuttitta F. The central role of adrenomedullin in host defense. J Leukoc Biol, 2006, 80:237-244.

1. Guignant C, Voirin N, Venet F, et al. Persistent high level of circulating midregional-proadrenomedullin and increased risk of nosocomial infections after septic shock. J Trauma Acute Care Surg, 2012, 72:293-296.
2. 中華醫學會重癥醫學分會.呼吸機相關性肺炎診斷、預防和治療指南(2013).中華內科雜志, 2013, 52:524-543.
3. Safdar N, Dezfulian C, Collard HR, et al. Clinical and economic consequences of ventilator-associated pneumonia:a systematic review. Crit Care Med, 2005, 33:2184-2193.
4. Cheng CW, Chien MH, Su SC, et al. New markers in pneumonia. Clin Chim Acta, 2013, 419:19-25.
5. Linssen CF, Bekers O, Drent M, et al. C-reactive protein and procalcitonin concentrations in bronchoalveolar lavage fluid as a predictor of ventilator-associated pneumonia. Ann Clin Biochem, 2008, 45:293-298.
6. 尹輝明, 楊宏亮, 劉繼民, 等.監測降鈣素原與感染細胞在呼吸機相關性肺炎的早期診斷價值.中國呼吸與危重監護雜志, 2012, 12:454-456.
7. Zielinska-Borkowska U, Skirecki T, Zlotorowicz M, et al. Procalcitonin in early onset ventilator-associated pneumonia. J Hosp Infect, 2012, 81:92-97.
8. Linscheid P, Seboek D, Zulewski H, et al. Autocrine/paracrine role of inflammation-mediated calcitonin gene-related peptide and adrenomedullin expression in human adipose tissue. Endocrinology, 2005, 146:2699-2708.
9. Miguel D, Prieto B, Costa M, et al. Cord blood plasma reference intervals for potential sepsis markers:pro-adrenomedullin, pro-endothelin, and pro-atrial natriuretic peptide. Clin Biochem, 2011, 44:337-341.
10. Debiane L, Hachem RY, Al Wohoush I, et al. The utility of proadrenomedullin and procalcitonin in comparison to C-reactive protein as predictors of sepsis and bloodstream infections in critically ill patients with cancer. Crit Care Med, 2014, 42:2500-2507.
11. Ruiz-Gonzalez A, Esquerda A, Porcel JM, et al. A pilot study on the diagnostic accuracy of proadrenomedullin and proatrial natriuretic peptide in lower respiratory tract infections. Open Respir Med J, 2014, 8:22-27.
12. 夏慶, 曹云, 楊毅, 等.血漿腎上腺髓質素前體在新生兒感染中的變化及其意義.中華圍產醫學雜志, 2010, 13:29-31.
13. Alcoba G, Manzano S, Lacroix L, et al. Proadrenomedullin and copeptin in pediatric pneumonia:a prospective diagnostic accuracy study. BMC Infect Dis, 2015, 15:347-350.
14. Florkowski CM. Sensitivity, specificity, receiver-operating characteristic (ROC) curves and likelihood ratios:communicating the performance of diagnostic tests. Clin Biochem Rev, 2008, 29:S83-87.
15. Zudaire E, Portal-Nunez S, Cuttitta F. The central role of adrenomedullin in host defense. J Leukoc Biol, 2006, 80:237-244.

Chinese Journal of Respiratory and Critical Care Medicine

The Diagnostic Value of Serum Proadrenomedullin in Ventilator-Associated Pneumonia

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