Impact of adrenomedullin levels on clinical risk stratification and outcome in subarachnoid haemorrhage

Maria Pilar Gracia Arnillas, Francisco Alvarez-Lerma, Jose Ramón Masclans, Jaume Roquer, Carolina Soriano, Demian Manzano, Ans Zapatero, Yolanda Diaz, Xavi Duran, Andrea Castellví, Elisa Cuadrado, Angel Ois

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Purpose: To use classification tree analysis to identify risk factors for nonsurvival in a neurological patients with subarachnoid haemorrhage (SAH) and to propose a clinical model for predicting of mortality. Methods: Prospective study of SAH admitted to a Critical Care Department and Stroke Unit over a 2-year period. Middle region of pro-ADM plasma levels (MR-proADM) was measured in EDTA plasma within the first 24 hours of hospital admission using the automatic immunofluorescence test. A regression tree was made to identify prognostic models for the development of mortality at 90 days. Results: Ninety patients were included. The mean MR-proADM plasma value in the samples analysed was 0.78 ± 0.41 nmol/L. MR-proADM plasma levels were significantly associated with mortality at 90 days (1.05 ± 0.51 nmol/L vs 0.64 ± 0.25 nmol/L; P <.001). Regression tree analysis provided an algorithm based on the combined use of clinical variables and one biomarker allowing accurate mortality discrimination of three distinct subgroups with high risk of 90-day mortality ranged from 75% to 100% (AUC 0.9; 95% CI 0.83-0.98). Conclusions: The study established a model (APACHE II, MR-proADM and Hunt&Hess) to predict fatal outcomes in patients with SAH. The proposed decision-making algorithm may help identify patients with a high risk of mortality.

Original languageEnglish
Article numbere13318
JournalEuropean Journal of Clinical Investigation
Issue number11
StatePublished - Nov 1 2020


  • adrenomedullin
  • critical care department
  • mortality
  • neurocritical patient
  • subarachnoid haemorrhage


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