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. 2021 Jan 7;21(1):23.
doi: 10.1186/s12879-020-05655-7.

Prognostic value of pro-adrenomedullin and copeptin in acute infective endocarditis

Rosa Zampino  1   2 , Domenico Iossa  3 , Maria Paola Ursi  1 , Lorenzo Bertolino  1 , Roberto Andini  2 , Rosa Molaro  3 , Oriana Fabrazzo  1 , Silvia Leonardi  4 , Luigi Atripaldi  4 , Emanuele Durante-Mangoni  5   6
Affiliations

Prognostic value of pro-adrenomedullin and copeptin in acute infective endocarditis

Rosa Zampino et al. BMC Infect Dis. .

Abstract

Background: Infective endocarditis (IE) is a life-threatening disease whose prognosis is often difficult to predict based on clinical data. Biomarkers have been shown to favorably affect disease management in a number of cardiac disorders. Aims of this retrospective study were to assess the prognostic role of procalcitonin (PCT), pro-adrenomedullin (pro-ADM) and copeptin in IE and their relation with disease characteristics and the traditional biomarker C-reactive protein (CRP).

Methods: We studied 196 patients with definite IE. Clinical, laboratory and echocardiography parameters were analyzed, with a focus on co-morbidities. PCT, pro-ADM and copeptin were measured on stored plasma samples obtained on admission during the acute phase of the disease.

Results: Pro-ADM and copeptin were significantly higher in older patients and associated with prior chronic kidney disease. Pro-ADM was an independent predictor of hospital mortality (OR 3.29 [95%C.I. 1.04-11.5]; p = 0.042) whilst copeptin independently predicted 1-year mortality (OR 2.55 [95%C.I. 1.18-5.54]; p = 0.017). A high PCT value was strictly tied with S. aureus etiology (p = 0.001). CRP was the only biomarker associated with embolic events (p = 0.003).

Conclusions: Different biomarkers correlate with distinct IE outcomes. Pro-ADM and copeptin may signal a worse prognosis of IE on admission to the hospital and could be used to identify patients who need more aggressive treatment. CRP remains a low-cost marker of embolic risk. A high PCT value should suggest S. aureus etiology.

Keywords: Biomarkers; Heart failure; Heart valve disease; Mortality; Organ dysfunction.

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Conflict of interest statement

Authors have no conflict of interest to disclose relevant to the content of this study. EDM received grant support and personal fees, outside of this work, from Roche, Pfizer, MSD, Angelini, Bio-Merieux, Abbvie, Nordic Pharma, Sanofi-Aventis, Medtronic, and DiaSorin. RZ and RA received personal fees, outside of this work, from Nordic Pharma.

Figures

Fig. 1
Fig. 1
ROC curve analysis of the predictive value for in-hospital mortality of the four analysed biomarkers. Footnote: For each of the analysed biomarker the area under the Receiver Operating Characteristic (ROC) curve is shown. Predictive power for the designated outcome was highest for pro-adrenomedullin and lowest for C-reactive protein
Fig. 2
Fig. 2
Biomarker levels according to IE causative pathogens. Footnote: Each bar depicts the median level of the designated biomarker among each subgroup of IE patients clustered according to the causative pathogen. The actual median value for plasma concentration is shown in the inset. Panel a: pro-adrenomedullin. Panel b: procalcitonin. Panel c: copeptin. Panel d: C-reactive protein
See this image and copyright information in PMC

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