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Assessment of pro-vasopressin and pro-adrenomedullin as predictors of 28-day mortality in septic shock patients

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Abstract

Purpose

Improvements in survival after septic shock will most likely rely on our capacity to manage individualized therapies based on the measurement of rapidly accessible biomarkers. As the early phase of septic shock is dominated by severe alterations of the cardiovascular system, the predictive value for mortality of pro-vasopressin (pro-AVP) and pro-adrenomedullin (pro-ADM), two vasoactive pro-hormones, was assessed.

Methods

In 99 consecutive patients, pro-hormone concentrations were measured (immunoluminometric assay) three times within the first week after the onset of septic shock.

Results

Pro-AVP and pro-ADM concentrations were significantly increased in non-survivors in comparison with survivors and were significantly associated with mortality after both univariate and multivariate analysis. Importantly, when assessed as a pair, pro-ADM and pro-AVP were even more informative.

Conclusions

Both Pro-ADM and pro-AVP appear to be good biomarkers for the prediction of 28-day mortality after septic shock. However, their association in a single variable tends to improve their predictive capacity.

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Acknowledgments

This work was supported by the Hospices Civils de Lyon and was conducted thanks to the support of Brahms—we especially thank Dr. N.G. Morgenthaler and Dr. A. Bergmann. All measurements were performed in the Research Department of Brahms AG in a totally blinded fashion without knowledge of clinical parameters. This work was also conducted thanks to the logistical support (H. Thizy, F. Gueyffier) from the Centre d’Investigation Clinique (CIC 201) de Lyon (Clinical Research Centre) of INSERM and Hospices Civils de Lyon.

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Authors and Affiliations

  1. Flow Cytometry Unit, Immunology Laboratory, Hôpital E. Herriot, Hospices Civils de Lyon, 5, Place d’Arsonval, 69437, Lyon cedex 03, France

    Caroline Guignant, Fabienne Venet, Françoise Poitevin, Christophe Malcus & Guillaume Monneret

  2. INSERM U271, Hospices Civils de Lyon, Hôpital E. Herriot, Service d’Hygiène, Epidémiologie et Prévention, Université de Lyon, Lyon, France

    Nicolas Voirin

  3. Intensive Care Units, Hospices Civils de Lyon, CH Lyon-Sud, Lyon, France

    Julien Bohé & Alain Lepape

Authors
  1. Caroline Guignant
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  2. Nicolas Voirin
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  3. Fabienne Venet
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  4. Françoise Poitevin
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  5. Christophe Malcus
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  6. Julien Bohé
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  7. Alain Lepape
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  8. Guillaume Monneret
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Corresponding author

Correspondence to Guillaume Monneret.

Additional information

This article is discussed in the editorial available at: doi:10.1007/s00134-009-1613-2.

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Guignant, C., Voirin, N., Venet, F. et al. Assessment of pro-vasopressin and pro-adrenomedullin as predictors of 28-day mortality in septic shock patients. Intensive Care Med 35, 1859–1867 (2009). https://doi.org/10.1007/s00134-009-1610-5

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  • DOI: https://doi.org/10.1007/s00134-009-1610-5

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