The value of midregional proadrenomedullin to predict mortality in intensive care unit

Aim: This study explores the value of midregional proadrenomedullin (mr-proADM), C-reactive protein (CRP), procalcitonin (PCT), and presepsin (PSP) in predicting mortality, considering both their absolute values at different time points and their dynamic kinetics. Methods: We conducted a retrospective observational study including all consecutive adult ICU admissions. Biomarkers were measured at admission (T0), day 3 (T3), and day 5 (T5). We assessed absolute values, relative variations, and categorized changes (≥50 % increase or decrease). Results: A total of 99 patients were included. mr-proADM at T3 had the highest predictive value for ICU mortality (AUC = 0.77), followed by PSP at T3 (AUC = 0.70). Cox regression identified mr-proADM at T3 as an independent predictor of mortality (HR: 1.16, p < 0.001), with a ≥ 50 % increase in mr-proADM from T0 to T3 significantly associated with mortality risk (HR: 4.15, p < 0.001). In patients with low baseline mr-proADM levels, a ≥ 50 % increase at T3 was significantly associated with mortality (HR: 4.43, p = 0.04), while in those with high baseline levels, the absolute value at T3 was more predictive. Conclusion: Our findings suggest that mr-proADM at T3 is the most informative biomarker for predicting ICU mortality, with its absolute value and dynamic increase providing valuable prognostic insights. Importantly, stratified analysis highlights that different risk stratification approaches may be necessary based on baseline mr-proADM levels.