Background
Early identification and treatment of patients with severe infections or sepsis remains challenging, and suitable biomarkers are lacking. This prospective exploratory pilot study aimed to evaluate the potential of point-of-care bioactive adrenomedullin (POC bio-ADM) in predicting bacteremia in patients presenting to the emergency department (ED) with suspected severe infections. Secondary objectives included its association with any infection, in-hospital mortality, intensive care unit (ICU) admission, and ICU length of stay.
Methods
In this prospective exploratory pilot cohort study, adult patients presenting to the ED of a German university hospital between December 2022 and September 2023 were enrolled. POC bio-ADM levels were analyzed using univariate and multivariable binary logistic regression and compared to established sepsis biomarkers (PCT, CRP, lactate).
Results
47 patients were included in the final analysis. POC bio-ADM was positive (> 45 pg/ml) in 38.3% (95% CI: 25.8–52.6%). Bacteremia was found in 34.0% (95% CI: 22.2–48.3%), and 78.7% (95% CI: 65.1–88.8%) had an infection. Positive POC bio-ADM was associated with significantly higher rates of bacteremia (55.6% vs. 20.7%). In the multivariable analysis, a positive POC bio-ADM was associated with an odds ratio (OR) of 5.318 (95% CI: 1.217–23.243) for bacteremia. Attributable in-hospital mortality was higher in patients with elevated POC bio-ADM (44.4% vs. 3.6%; OR: 21.6, 95% CI: 2.4-195.3).
Conclusion
This small, single-centre pilot exploratory study suggests that POC bio-ADM may help identify ED patients with suspected severe infection at increased risk of bacteremia and in-hospital mortality; these findings are hypothesis-generating and require confirmation in larger cohorts.