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dc.contributor.authorTolppanen H
dc.contributor.authorRivas-Lasarte M
dc.contributor.authorLassus J
dc.contributor.authorSans-Roselló J
dc.contributor.authorHartmann O
dc.contributor.authorLindholm M
dc.contributor.authorArrigo M
dc.contributor.authorTarvasmäki T
dc.contributor.authorKöber L
dc.contributor.authorThiele H
dc.contributor.authorPulkki K
dc.contributor.authorSpinar J
dc.contributor.authorParissis J
dc.contributor.authorBanaszewski M
dc.contributor.authorSilva-Cardoso J
dc.contributor.authorCarubelli V
dc.contributor.authorSionis A
dc.contributor.authorHarjola V-P
dc.contributor.authorMebazaa A
dc.date.accessioned2017-09-20T10:06:24Z
dc.date.available2017-09-20T10:06:24Z
dc.date.issued2017
dc.identifier.urihttps://erepo.uef.fi/handle/123456789/4315
dc.description.abstractBackground The clinical CardShock risk score, including baseline lactate levels, was recently shown to facilitate risk stratification in patients with cardiogenic shock (CS). As based on baseline parameters, however, it may not reflect the change in mortality risk in response to initial therapies. Adrenomedullin is a prognostic biomarker in several cardiovascular diseases and was recently shown to associate with hemodynamic instability in patients with septic shock. The aim of our study was to evaluate the prognostic value and association with hemodynamic parameters of bioactive adrenomedullin (bio-ADM) in patients with CS. Methods CardShock was a prospective, observational, European multinational cohort study of CS. In this sub-analysis, serial plasma bio-ADM and arterial blood lactate measurements were collected from 178 patients during the first 10 days after detection of CS. Results Both bio-ADM and lactate were higher in 90-day non-survivors compared to survivors at all time points (P < 0.05 for all). Lactate showed good prognostic value during the initial 24 h (AUC 0.78 at admission and 0.76 at 24 h). Subsequently, lactate returned normal (≤2 mmol/L) in most patients regardless of later outcome with lower prognostic value. By contrast, bio-ADM showed increasing prognostic value from 48 h and beyond (AUC 0.71 at 48 h and 0.80 at 5–10 days). Serial measurements of either bio-ADM or lactate were independent of and provided added value to CardShock risk score (P < 0.001 for both). Ninety-day mortality was more than double higher in patients with high levels of bio-ADM (>55.7 pg/mL) at 48 h compared to those with low bio-ADM levels (49.1 vs. 22.6%, P = 0.001). High levels of bio-ADM were associated with impaired cardiac index, mean arterial pressure, central venous pressure, and systolic pulmonary artery pressure during the study period. Furthermore, high levels of bio-ADM at 48 to 96 h were related to persistently impaired cardiac and end-organ function. Conclusions Bio-ADM is a valuable prognosticator and marker of impaired hemodynamics in CS patients. High levels of bio-ADM may show shock refractoriness and developing end-organ dysfunction and thus help to guide therapeutic approach in patients with CS.en
dc.language.isoENen
dc.publisherSpringer Natureen
dc.relation.ispartofseriesAnnals of intensive careen
dc.relation.urihttp://dx.doi.org/10.1186/s13613-016-0229-2en
dc.rightsCC BY http://creativecommons.org/licenses/by/4.0/en
dc.subjectAdrenomedullinen
dc.subjectCardiogenic shocken
dc.subjectBiomarkersen
dc.subjectLactateen
dc.subjectHemodynamicsen
dc.subjectMortalityen
dc.titleAdrenomedullin: a marker of impaired hemodynamics, organ dysfunction, and poor prognosis in cardiogenic shocken
dc.description.versionpublished versionen
dc.contributor.departmentSchool of Medicine / Clinical Medicineen
uef.solecris.id46464729en
dc.type.publicationinfo:eu-repo/semantics/articleen
dc.rights.accessrights© Authorsen
dc.relation.doi10.1186/s13613-016-0229-2en
dc.description.reviewstatuspeerRevieweden
dc.format.pagerange1-10en
dc.relation.issn2110-5820en
dc.relation.issue1en
dc.relation.volume7en
dc.rights.accesslevelopenAccessen
dc.type.okmA1en
dc.type.versioninfo:eu-repo/semantics/publishedVersionen


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