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Vol. 67. Issue 1.
Pages 8-14 (January 2020)
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Vol. 67. Issue 1.
Pages 8-14 (January 2020)
Original article
Pre-Operative pro-adrenomedullin as a predictor of postoperative requirement of organ support in patients scheduled for major abdominal surgery.
Pro-adrenomedulina preoperatoria como predictor de necesidad de soporte orgánico postoperatorio en pacientes programados para cirugía abdominal mayor. Estudio piloto prospectivo observacional
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F. Ramasco Ruedaa,
Corresponding author
gorria66@gmail.com

Corresponding author.
, A. Planas Rocaa, A. Figuerola Tejerinab, R. Méndez Hernándeza, F. Gilsanz Rodriguezc
a Servicio de Anestesia, Cuidados Críticos Quirúrgicos, Hospital Universitario de La Princesa, Madrid, Spain
b Departamento de Medicina Preventiva y Salud Pública, Hospital Universitario de La Princesa, Madrid, Spain
c Servicio de Anestesia, Cuidados Críticos Quirúrgicos, Hospital Universitario La Paz, Madrid, Spain
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Figures (1)
Tables (3)
Table 1. Type of surgical intervention.
Table 2. Predictive capacity of MR-ProADM ≥ 0.87nmol/L.
Table 3. Univariate analysis of the association according to levels of MR-ProADM.
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Abstract
Background

Mid-Regional-Pro-Adrenomedullin (MR-Pro-ADM) is a marker of severity in a wide spectrum of pathological conditions, such as sepsis, and cardiovascular dysfunction. Its usefulness as a predictor of morbidity and mortality in surgical patients has yet to be elucidated. We examined the ability of preoperative MR-proADM to predict the need for postoperative organ support (POS).

Methods

Single-centre, pilot, prospective observational cohort study, enrolling adult patients scheduled for major abdominal surgery. The accuracy of the MR-pro-ADM to predict POS was determined by area under the receiver operating characteristic curve (AUROC) analysis. A univariate analysis was performed to identify the association of POS and the MR-ProA-DM value with the best combination of sensitivity and specificity.

Results

A total of 59 patients scheduled for major abdominal surgery were enrolled. The incidence of POS was 13.6%. The association of MR-Pro-ADM levels with the incidence of POS was determined by an area under the ROC curve of 0.85 (95% CI: 0.74–0.96, p=0.002). The preoperative value of MR-Pro-ADM with the best combination of sensitivity and specificity to predict POS was 0.87nmol/L. Patients with preoperative serum levels of MR-Pro-ADM ≥ 0.87nmol/L had a significantly higher incidence of POS (33.3% vs 4.9%, p=0.007). MR-Pro-ADM ≥ 0.87nmol/L was shown to be an independent risk factor for POS (p=0.001; OR 9.758; 95% CI 1.73–54.78) in the multivariate analysis.

Conclusion

The preoperative serum level of MR-Pro-ADM may be a biomarker of perioperative risk in adult patients scheduled for major abdominal surgery.

Keywords:
Proadrenomedullin
Postoperative requirement of organ support
Biomarker
Perioperative risk
Resumen
Introducción

La Region Medial de Pro-Adrenomedulina (MR-Pro-ADM) es un marcador de gravedad en un amplio espectro de enfermedades como la sepsis y la disfunción cardiovascular. Su utilidad como predictor de morbilidad y mortalidad en pacientes quirúrgicos aún no se ha dilucidado. Examinamos en este estudio la capacidad del valor preoperatorio de MR-proADM para predecir la necesidad de Soporte Orgánico Postoperatorio (SOP).

Método

Estudio observacional prospectivo piloto, en un solo centro, que incluyó a pacientes adultos programados para cirugía abdominal mayor. La capacidad de MR- pro-ADM para predecir la necesidad de SOP se determinó por el análisis del área bajo la curva de características operativas del receptor (AUROC). Se realizó un análisis univariante para identificar la asociación entre el valor preoperatorio de MR-ProA-DM con la mejor combinación de sensibilidad y especificidad, y la necesidad de Soporte Orgánico Postoperatorio (SOP).

Resultados

Se reclutaron un total de 59 pacientes programados para cirugía abdominal mayor. La incidencia de SOP fue del 13.6%. Para la asociación entre los niveles de MR-Pro-ADM y la incidencia de SOP se obtuvo un área bajo la curva ROC de 0,85 (IC del 95%: 0,74–0,96, p=0,002). El valor preoperatorio de MR-Pro-ADM con la mejor combinación de sensibilidad y especificidad para predecir SOP fue de 0,87nmol / L. Los pacientes con niveles séricos preoperatorios de MR-Pro-ADM ≥ 0,87nmol / L tuvieron una incidencia significativamente mayor de SOP (33.3% vs 4.9%, p=0.007). Niveles séricos preoperatorios de MR-Pro-ADM ≥ 0,87nmol / L mostraron ser un factor independiente de riesgo en la necesidad de SOP (p=0.001; OR 9.758; IC 1.73–54.78) en el análisis multivariante.

Conclusión

El valor sérico preoperatorio de MR-Pro-ADM puede ser un biomarcador útil del riesgo perioperatorio y de la necesidad de soporte orgánico postoperatorio en pacientes adultos programados para cirugía abdominal mayor.

Palabras clave:
Proadrenomedulina
Soporte orgánico postoperatorio
Biomarcador
Riesgo perioperatorio

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