Elevated Plasma Bioactive Adrenomedullin and Mortality in Cardiogenic Shock: Results from the OptimaCC Trial

Abstract

Aims: Bioactive adrenomedullin (bio-ADM) was recently shown to be a prognostic marker in patients with acute circulatory failure. We investigate the association of bio-ADM with organ injury, functional impairment, and survival in cardiogenic shock (CS). Methods: OptimaCC was a multicenter and randomized trial in 57 patients with CS. In this post-hoc analysis, the primary endpoint was to assess the association between bio-ADM and 30-day all-cause mortality. Secondary endpoints included adverse events and parameters of organ injury or functional impairment. Results: Bio-ADM values were higher in 30-day non-survivors than 30-day survivors at inclusion (median (interquartile range) 67.0 (54.6–142.9) pg/mL vs. 38.7 (23.8–63.6) pg/mL, p = 0.010), at 24 h (p = 0.012), and up to 48 h (p = 0.027). Using a bio-ADM cutoff of 53.8 pg/mL, patients with increased bio-ADM had a HR of 3.90 (95% confidence interval 1.43–10.68, p = 0.008) for 30-day all-cause mortality, and similar results were observed even after adjustment for severity scores. Patients with the occurrence of refractory CS had higher bio-ADM value at inclusion (90.7 (59.9–147.7) pg/mL vs. 40.7 (23.0–64.7) pg/mL p = 0.005). Bio-ADM values at inclusion were correlated with pulmonary vascular resistance index, estimated glomerular filtration rate, and N-terminal pro-B-type natriuretic peptide (r = 0.49, r = –0.47, and r = 0.64, respectively; p < 0.001). Conclusions: In CS patients, the values of bio-ADM are associated with some parameters of organ injury and functional impairment and are prognostic for the occurrence of refractory CS and 30-day mortality.

Biologically active adrenomedullin as a marker for residual congestion and early rehospitalization in patients hospitalized for acute heart failure: Data from STRONG‐HF

“…Patients with the highest baseline bio‐ADM levels were at the highest risk of the primary endpoint of 180‐day all‐cause mortality or HF hospitalization and 180‐day HF hospitalization. This is similar to findings from BIOSTAT‐CHF, PROTECT and in the OptimaCC trial 11,15,26 . Patients with higher bio‐ADM are generally sicker patients, showing more signs and symptoms of HF, which might partly explain the increased mortality and rehospitalization risk.…”

“…This is similar to findings from BIOSTAT-CHF, PROTECT and in the OptimaCC trial. 11,15,26 Patients with higher bio-ADM are generally sicker patients, showing more signs and symptoms of HF, which might partly explain the increased mortality and rehospitalization risk. The risk was especially high in patients with bio-ADM in the upper tertile, whose bio-ADM levels were mostly above the 97.5th percentile of healthy volunteers, suggesting that a cut-off of 29 pg/ml may be considered as a marker of higher risk for acute HF patients.…”