liu.seSearch for publications in DiVA
Change search
ReferencesLink to record
Permanent link

Direct link
Adrenomedullin and endothelin-1 are associated with myocardial injury and death in septic shock patients
Skåne University Hospital Malmö, Sweden.
Skåne University Hospital Malmö, Sweden.
Skåne University Hospital Malmö, Sweden.
Skåne University Hospital Malmö, Sweden.
Show others and affiliations
2016 (English)In: Critical Care, ISSN 1364-8535, E-ISSN 1466-609X, Vol. 20, no 178Article in journal (Refereed) PublishedText
Abstract [en]

Background: Adrenomedullin and endothelin-1 are hormones with opposing effects on the cardiovascular system. Adrenomedullin acts as a vasodilator and seems to be important for the initiation and continuation of the hyperdynamic circulatory response in sepsis. Endothelin-1 is a vasoconstrictor and has been linked to decreased cardiac performance. Few studies have studied the relationship between adrenomedullin and endothelin-1, and morbidity and mortality in septic shock patients. High-sensitivity troponin T (hsTNT) is normally used to diagnose acute cardiac injury but is also prognostic for outcome in intensive care. We investigated the relationship between mid-regional pro-adrenomedullin (MR-proADM), C-terminal pro-endothelin-1 (CT-proET-1), and myocardial injury, measured using transthoracic echocardiography and hsTNT in septic shock patients. We were also interested in the development of different biomarkers throughout the ICU stay, and how early measurements were related to mortality. Further, we assessed if a positive biomarker panel, consisting of MR-proADM, CT-proET-1, and hsTNT changed the odds for mortality. Methods: A cohort of 53 consecutive patients with septic shock had their levels of MR-proADM, CT-proET-1, hsTNT, and left ventricular systolic functions prospectively measured over 7 days. The relationship between day 1 levels of MR-proADM/CT-proET-1 and myocardial injury was studied. We also investigated the relationship between biomarkers and early (7-day) and later (28-day) mortality. Likelihood ratios, and pretest and posttest odds for mortality were calculated. Results: Levels of MR-proADM and CT-proET-1 were significantly higher among patients with myocardial injury and were correlated with left ventricular systolic dysfunction. MR-proADM and hsTNT were significantly higher among 7-day and 28-day non-survivors. CT-proET-1 was also significantly higher among 28-day but not 7-day non-survivors. A positive biomarker panel consisting of the three biomarkers increased the odds for mortality 13-fold to 20-fold. Conclusions: MR-proADM and CT-proET-1 are associated with myocardial injury. A biomarker panel combining MR-proADM, CT-proET-1, and hsTNT increases the odds ratio for death, and may improve currently available scoring systems in critical care.

Place, publisher, year, edition, pages
BIOMED CENTRAL LTD , 2016. Vol. 20, no 178
Keyword [en]
Sepsis; Shock; Adrenomedullin; Endothelin-1; High-sensitivity troponin; Echocardiography; Myocardial injury; Mortality; Likelihood ratio
National Category
Cardiac and Cardiovascular Systems
URN: urn:nbn:se:liu:diva-130131DOI: 10.1186/s13054-016-1361-yISI: 000377718800001PubMedID: 27282767OAI: diva2:948570

Funding Agencies|Region Halland County Council

Available from: 2016-07-12 Created: 2016-07-11 Last updated: 2016-08-05

Open Access in DiVA

fulltext(838 kB)10 downloads
File information
File name FULLTEXT01.pdfFile size 838 kBChecksum SHA-512
Type fulltextMimetype application/pdf

Other links

Publisher's full textPubMed

Search in DiVA

By author/editor
Chew, Michelle
By organisation
Division of Drug ResearchFaculty of Medicine and Health Sciences
In the same journal
Critical Care
Cardiac and Cardiovascular Systems

Search outside of DiVA

GoogleGoogle Scholar
Total: 10 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Altmetric score

Total: 8 hits
ReferencesLink to record
Permanent link

Direct link