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Original communication

Postoperatively increased bioactive adrenomedullin is related to adverse outcome after complex aortic surgery

Published Online:February 03, 2020https://doi.org/10.1024/0301-1526/a000848

Abstract

Summary:Background: Open and endovascular thoracoabdominal aortic aneurysm repair is related to major complications and increased mortality rates. Up to now, specific biomarkers for adverse outcome are scarce, although routine usage of such biomarkers could enable an earlier and more appropriate treatment of complications during the postoperative course after complex aortic aneurysm repair. Patients and methods: In a prospective single-center study including 33 patients (48.5 % women, mean age 63.0 ± 16.2 years) undergoing elective complex open and endovascular aortic aneurysm repair, bioactive adrenomedullin (bio-ADM) was measured for 72 h perioperatively and an association with clinical endpoints, namely cardiogenic shock, death and the combined endpoint of the two aforementioned parameters was assessed. Furthermore, the association between bio-ADM and baseline characteristics and perioperative details including sepsis biomarkers score were assessed. Results: 51.5 % (n = 17) of patients developed postoperative acute kidney injury, 21.2 % (n = 7) pneumonia and 18.2 % (n = 6) sepsis. Cardiogenic shock was observed in 12.1 % (n = 4) patients. The in-hospital mortality rate was 18.2 % (n = 6), and 24.2 % (n = 8) of patients developed cardiogenic shock and/or died in hospital. A significant correlation of bio-ADM concentrations from all available time points was observed with leukocytes (r = 0.37, P < 0.0001), C-reactive protein (r = 0.56, P < 0.001) and serum creatinine levels (r = 0.52, P < 0.001). Increased bio-ADM at 12 h, 24 h, 48 h and 72 h after admission to ICU was associated with both, in-hospital death and cardiogenic shock, with an area under the curve for the combined endpoint of 0.598, 0.720, 0.880 and 0.967. Bio-ADM concentrations at 48 h and 72 h after admission to ICU were predictive for in-hospital death and cardiogenic shock (both P < 0.01). Conclusions: Bio-ADM may serve as postoperative biomarker for cardiogenic shock and death after complex open and endovascular aortic aneurysm repair, potentially enabling an earlier and by that more adequate treatment of adverse outcome after major surgery.

References

  • 1 Law Y, Tsilimparis N, Rohlffs F, Makaloski V, Behrendt CA, Heidemann F, et al. Fenestrated or branched endovascular aortic repair for postdissection thoracoabdominal aortic aneurysm. J Vasc Surg. 2019;70(2):404–12. First citation in articleCrossref Medline, Google Scholar

  • 2 Gombert A, Kirner L, Ketting S, Ruckbeil MV, Mees B, Barbati ME, et al. Editor’s Choice - Outcomes After One Stage Versus Two Stage Open Repair of Type II Thoraco-abdominal Aortic Aneurysms. Eur J Vasc Endovasc Surg. 2019;57(3):340–8. First citation in articleCrossref Medline, Google Scholar

  • 3 Norwood MG, Bown MJ, Lloyd G, Bell PR, Sayers RD. The clinical value of the systemic inflammatory response syndrome (SIRS) in abdominal aortic aneurysm repair. Eur J Vasc Endovasc Surg. 2004;27(3):292–8. First citation in articleCrossref Medline, Google Scholar

  • 4 Bown MJ, Nicholson ML, Bell PR, Sayers RD. Cytokines and inflammatory pathways in the pathogenesis of multiple organ failure following abdominal aortic aneurysm repair. Eur J Vasc Endovasc Surg. 2001;22(6):485–95. First citation in articleCrossref Medline, Google Scholar

  • 5 Fink MP. Thoracoabdominal aortic aneurysm repair: a human model of ischemia/reperfusion-induced cytokine-driven multiple organ dysfunction syndrome. Crit Care Med. 2000;28(9):3356–7. First citation in articleCrossref Medline, Google Scholar

  • 6 O’Donnell TFX, Boitano LT, Deery SE, Schermerhorn ML, Schanzer A, Beck AW, et al. Open Versus Fenestrated Endovascular Repair of Complex Abdominal Aortic Aneurysms. Ann Surg. 2019. doi: 10.1097/SLA.0000000000003094. [Epub ahead of print]. First citation in articleCrossref Medline, Google Scholar

  • 7 De La Motte L, Vogt K, Panduro Jensen L, Groenvall J, Kehlet H, Veith Schroeder T, et al. Incidence of systemic inflammatory response syndrome after endovascular aortic repair. J Cardiovasc Surg (Torino). 2011;52(1):73–9. First citation in articleMedline, Google Scholar

  • 8 Martin L, Gombert A, Chen J, Liebens J, Verleger J, Kalder J, et al. The beta-d-Endoglucuronidase Heparanase Is a Danger Molecule That Drives Systemic Inflammation and Correlates with Clinical Course after Open and Endovascular Thoracoabdominal Aortic Aneurysm Repair: Lessons Learnt from Mice and Men. Front Immunol. 2017;8:681. First citation in articleCrossref Medline, Google Scholar

  • 9 Tsilimigras DI, Sigala F, Karaolanis G, Ntanasis-Stathopoulos I, Spartalis E, Spartalis M, et al. Cytokines as biomarkers of inflammatory response after open versus endovascular repair of abdominal aortic aneurysms: a systematic review. Acta Pharmacol Sin. 2018;39(7):1164–75. First citation in articleCrossref Medline, Google Scholar

  • 10 van Beest PA, Brander L, Jansen SP, Rommes JH, Kuiper MA, Spronk PE, Cumulative lactate and hospital mortality in ICU patients. Ann Intensive Care. 2013;3(1):6. First citation in articleCrossref Medline, Google Scholar

  • 11 Caironi P, Latini R, Struck J, Hartmann O, Bergmann A, Maggio G, et al. Circulating Biologically Active Adrenomedullin (bio-ADM) Predicts Hemodynamic Support Requirement and Mortality During Sepsis. Chest. 2017;152(2):312–20. First citation in articleCrossref Medline, Google Scholar

  • 12 Geven C, Kox M, Pickkers P. Adrenomedullin and Adrenomedullin-Targeted Therapy As Treatment Strategies Relevant for Sepsis. Front Immunol. 2018;9:292. First citation in articleCrossref Medline, Google Scholar

  • 13 Beltowski J, Jamroz A. Adrenomedullin–what do we know 10 years since its discovery? Pol J Pharmacol. 2004;56(1):5–27. First citation in articleMedline, Google Scholar

  • 14 Crawford ES. Thoraco-abdominal and abdominal aortic aneurysms involving renal, superior mesenteric, celiac arteries. Ann Surg. 1974;179(5):763–72. First citation in articleCrossref Medline, Google Scholar

  • 15 Figueiredo N. Motor exam of patients with spinal cord injury: a terminological imbroglio. Neurol Sci. 2017;38(7):1159–65. First citation in articleCrossref Medline, Google Scholar

  • 16 American Thoracic S. Infectious Diseases Society of A. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171(4):388–416. First citation in articleCrossref Medline, Google Scholar

  • 17 De Leyn P, Bedert L, Delcroix M, Depuydt P, Lauwers G, Sokolov Y, et al. Tracheotomy: clinical review and guidelines. Eur J Cardiothorac Surg. 2007;32(3):412–21. First citation in articleCrossref Medline, Google Scholar

  • 18 Kurmani S, Squire I. Acute Heart Failure: Definition, Classification and Epidemiology. Curr Heart Fail Rep. 2017;14(5):385–92. First citation in articleCrossref Medline, Google Scholar

  • 19 Asaria P, Elliott P, Douglass M, Obermeyer Z, Soljak M, Majeed A, et al. Acute myocardial infarction hospital admissions and deaths in England: a national follow-back and follow-forward record-linkage study. Lancet Public Health. 2017;2(4):e191–e201. First citation in articleCrossref Medline, Google Scholar

  • 20 Weissler-Snir A, Adler A, Williams L, Gruner C, Rakowski H. Prevention of sudden death in hypertrophic cardiomyopathy: bridging the gaps in knowledge. Eur Heart J. 2017;38(22):1728–37. First citation in articleMedline, Google Scholar

  • 21 Lamb EJ, Levey AS, Stevens PE. The Kidney Disease Improving Global Outcomes (KDIGO) guideline update for chronic kidney disease: evolution not revolution. Clin Chem. 2013;59(3):462–5. First citation in articleCrossref Medline, Google Scholar

  • 22 Seymour CW, Liu VX, Iwashyna TJ, Brunkhorst FM, Rea TD, Scherag A, et al. Assessment of Clinical Criteria for Sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):762–74. First citation in articleCrossref Medline, Google Scholar

  • 23 Vincent JL, Opal SM, Marshall JC, Tracey KJ. Sepsis definitions: time for change. Lancet. 2013;381(9868):774–5. First citation in articleCrossref Medline, Google Scholar

  • 24 Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992;101(6):1644–55. First citation in articleCrossref Medline, Google Scholar

  • 25 Marino R, Struck J, Maisel AS, Magrini L, Bergmann A, Di Somma S. Plasma adrenomedullin is associated with short-term mortality and vasopressor requirement in patients admitted with sepsis. Crit Care. 2014;18(1):R34. First citation in articleCrossref Medline, Google Scholar

  • 26 Jacobs MJ, Mommertz G, Koeppel TA, Langer S, Nijenhuis RJ, Mess WH, et al. Surgical repair of thoracoabdominal aortic aneurysms. J Cardiovasc Surg (Torino). 2007;48(1):49–58. First citation in articleMedline, Google Scholar

  • 27 Mommertz G, Sigala F, Langer S, Koeppel TA, Mess WH, Schurink GW, et al. Thoracoabdominal aortic aneurysm repair in patients with marfan syndrome. Eur J Vasc Endovasc Surg. 2008;35(2):181–6. First citation in articleCrossref Medline, Google Scholar

  • 28 Jacobs MJ, Schurink GW. Open repair in chronic type B dissection with connective tissue disorders. Ann Cardiothorac Surg. 2014;3(3):325–8. First citation in articleMedline, Google Scholar

  • 29 Jacobs MJ, Elenbaas TW, Schurink GW, Mess WH, Mochtar B. Assessment of spinal cord integrity during thoracoabdominal aortic aneurysm repair. Ann Thorac Surg. 2002;74(5):S1864–6; discussion S92–8. First citation in articleCrossref Medline, Google Scholar

  • 30 Tshomba Y, Baccellieri D, Mascia D, Kahlberg A, Rinaldi E, Melissano G, et al. Open treatment of extent IV thoracoabdominal aortic aneurysms. J Cardiovasc Surg (Torino). 2015;56(5):687–97. First citation in articleMedline, Google Scholar

  • 31 O’Brien N, Sobocinski J, d’Elia P, Guillou M, Maioli F, Azzaoui R, et al. Fenestrated endovascular repair of type IV thoracoabdominal aneurysms: device design and implantation technique. Perspect Vasc Surg Endovasc Ther. 2011;23(3):173–7. First citation in articleCrossref Medline, Google Scholar

  • 32 Canyigit M, Cetin L, Uguz E, Algin O, Kucuker A, Arslan H, et al. Reduction of iodinated contrast load with the renal artery catheterization technique during endovascular aortic repair. Diagn Interv Radiol. 2013;19(3):244–50. First citation in articleMedline, Google Scholar

  • 33 Kim H, Hur M, Struck J, Bergmann A, Di Somma S. Circulating Biologically Active Adrenomedullin Predicts Organ Failure and Mortality in Sepsis. Ann Lab Med. 2019;39(5):454–63. First citation in articleCrossref Medline, Google Scholar

  • 34 Mebazaa A, Geven C, Hollinger A, Wittebole X, Chousterman BG, Blet A, et al. Circulating adrenomedullin estimates survival and reversibility of organ failure in sepsis: the prospective observational multinational Adrenomedullin and Outcome in Sepsis and Septic Shock-1 (AdrenOSS-1) study. Crit Care. 2018;22(1):354. First citation in articleCrossref Medline, Google Scholar

  • 35 Gillmann HJ, Meinders A, Larmann J, Sahlmann B, Schrimpf C, Aper T, et al. Adrenomedullin Is Associated With Surgical Trauma and Impaired Renal Function in Vascular Surgery Patients. J Intensive Care Med. 2019;34(1):67–76. First citation in articleCrossref Medline, Google Scholar

  • 36 Tolppanen H, Rivas-Lasarte M, Lassus J, Sans-Rosello J, Hartmann O, Lindholm M, et al. Adrenomedullin: a marker of impaired hemodynamics, organ dysfunction, and poor prognosis in cardiogenic shock. Ann Intensive Care. 2017;7(1):6. First citation in articleCrossref Medline, Google Scholar

  • 37 Spanos K, Kolbel T, Kubitz JC, Wipper S, Konstantinou N, Heidemann F, et al. Risk of spinal cord ischemia after fenestrated or branched endovascular repair of complex aortic aneurysms. J Vasc Surg. 2019;69(2):357–66. First citation in articleCrossref Medline, Google Scholar

  • 38 Gombert A, Kirner L, Ketting S, Ruckbeil MV, Mees B, Barbati ME, et al. Outcomes After One Stage Versus Two Stage Open Repair of Type II Thoraco-abdominal Aortic Aneurysms. Eur J Vasc Endovasc Surg. 2018. First citation in articleGoogle Scholar

  • 39 Gombert A, Prior I, Martin L, Grommes J, Barbati ME, Foldenauer AC, et al. Urine neutrophil gelatinase–associated lipocalin predicts outcome and renal failure in open and endovascular thoracic abdominal aortic aneurysm surgery. Scientific Reports. 2018;8(1):12676. First citation in articleCrossref Medline, Google Scholar

  • 40 Locham S, Dakour-Aridi H, Nejim B, Dhaliwal J, Alshwaily W, Malas M. Outcomes and cost of open versus endovascular repair of intact thoracoabdominal aortic aneurysm. J Vasc Surg. 2018;68(4):948–55 e1. First citation in articleCrossref Medline, Google Scholar

  • 41 Geven C, Bergmann A, Kox M, Pickkers P. Vascular Effects of Adrenomedullin and the Anti-Adrenomedullin Antibody Adrecizumab in Sepsis. Shock. 2018. First citation in articleGoogle Scholar

  • 42 Qiao Z, Wang W, Yin L, Luo P, Greven J, Horst K, et al. Using IL-6 concentrations in the first 24 h following trauma to predict immunological complications and mortality in trauma patients: a meta-analysis. Eur J Trauma Emerg Surg. 2018;44(5):679–87. First citation in articleCrossref Medline, Google Scholar

  • 43 Schoe A, Schippers EF, Struck J, Ebmeyer S, Klautz RJ, de Jonge E, et al. Postoperative pro-adrenomedullin levels predict mortality in thoracic surgery patients: comparison with Acute Physiology and Chronic Health Evaluation IV Score*. Crit Care Med. 2015;43(2):373–81. First citation in articleCrossref Medline, Google Scholar

  • 44 Simon TP, Martin L, Doemming S, Humbs A, Bruells C, Kopp R, et al. Plasma adrenomedullin in critically ill patients with sepsis after major surgery: A pilot study. J Crit Care. 2017;38:68–72. First citation in articleCrossref Medline, Google Scholar

  • 45 Kitamura K, Kangawa K, Kawamoto M, Ichiki Y, Nakamura S, Matsuo H, et al. Adrenomedullin: a novel hypotensive peptide isolated from human pheochromocytoma. Biochem Biophys Res Commun. 1993;425(3):548–55. First citation in articleCrossref, Google Scholar

  • 46 Eto T. A review of the biological properties and clinical implications of adrenomedullin and proadrenomedullin N-terminal 20 peptide (PAMP), hypotensive and vasodilating peptides. Peptides. 2001;22(11):1693–711. First citation in articleCrossref Medline, Google Scholar