Usefulness of midregional pro-adrenomedullin as a marker of organ damage and predictor of mortality in patients with sepsis.

BACKGROUND: Midregional proadrenomedullin (MR-proADM) is a prognostic biomarker in patients with community-acquired pneumonia (CAP) and sepsis. In this paper, we examined the ability of MR-proADM to predict organ damage and long-term mortality in sepsis patients, compared to that of procalcitonin, C-reactive protein and lactate. METHODS: This was a prospective observational cohort, enrolling severe sepsis or septic shock patients admitted to internal service department. The association between biomarkers and 90-day mortality was assessed by Cox regression analysis and Kaplan-Meier curves. The accuracy of biomarkers for mortality was determined by area under the receiver operating characteristic curve (AUROC) analysis. RESULTS: A total of 148 patients with severe sepsis, according to the criteria of the campaign to survive sepsis, were enrolled. Eighty-five (57.4%) had sepsis according to the new criteria of Sepsis-3. MR-proADM showed the best AUROC to predict sepsis as defined by the Sepsis-3 criteria (AUROC of 0.771, 95% CI 0.692-0.850, p <0.001) and was the only marker independently associated with Sepsis-3 criteria (OR = 4.78, 95% CI 2.25-10.14; p < 0.001) in multivariate analysis. MR-proADM was the biomarker with the best AUROC to predict mortality in 90 days (AUROC of 0.731, CI 95% 0.612-0.850, p <0.001) and was the only marker that kept its independence [hazard ratio (HR) of 1.4, 95% CI 1.2-1.64, p <0.001] in multivariate analysis. The cut-off point of MR-proADM of 1.8 nmol/L (HR of 4.65, 95% CI 6.79-10.1, p < 0.001) was the one that had greater discriminative capacity to predict 90 days mortality. All patients with MR-proADM concentrations ≤0.60 nmol/L survived up to 90 days. In patients with SOFA ≤ 6, the addition of MR-proADM to SOFA score increased the ability of SOFA to identify non-survivors, AUROC of 0.65 (CI 95% 0.537-0.764) and AUROC of 0.700 (CI 95% 0.594-0.800), respectively (p < 0.05 for both). CONCLUSIONS: MR-proADM is a good biomarker in the early identification of high risk septic patients and may contribute to improve the predictive capacity of SOFA scale, especially when scores are low.

Artículos publicados en EMERGENCIAS entre 2000 y 2004: participación de los urgenciólogos y comparación con su aportación en las revistas indexadas / Scientific papers published in “EMERGENCIAS” from 2000 to 2004: participation of emergency department physicians and comparison with their contribution to indexed journals

Objetivos: Analizar las principales características de la producción científica de los urgenciólogos españoles entre 2000 y 2004, tanto en revistas indexadas por el Scienci Citation Index (SCI) como en la revista EMERGENCIAS, al no encontrarse ésta incluida endicha base de datos. Método: Se revisaron manualmente todos los documentos publicados en EMERGENCIAS durante el período 2000-2004. Se aceptó como documento de un urgenciólogo español si en la filiación figuraba su erradicación en España y cualquiera de las siguientes expresiones identificativas de un servicio-dispositivo de urgencias: urgencias, urgències,urxencias, larrialdiak, larrialdia, emergentziak, emergencias, emergències, emerxencias,emergency, 061, SAMU, 1006, SUC, SEM, SEMSA, SERCAM, 112, DEIAK o EPES. Esta misma estrategia fue la utilizada para la búsqueda en revistas del SCI durante el mismo período. Se registraron y analizaron los principales datos e indicadores bibliométricos utilizados en los estudios previos de nuestro grupo. Para determinar las líneas de investigación se utilizó el índice del Tratado de Medicina de Urgencias de Tintinalli,ligeramente modificado. Resultados: En el periodo estudiado, los urgenciólogos españoles publicaron 594 documentos,290 en EMERGENCIAS y 304 indexados por el SCI. El 51% de ellos fueron realizados por autores pertenecientes a 26 servicios de urgencias hospitalarios y 3 Sistemas de Emergencias, además de la propia SEMES. Hubo diferencias importantes entre la aportación que realizó cada Comunidad y cada Centro a EMERGENCIAS y al SCI en cuanto a la producción científica, en las características bibliométricas y en los temas delos trabajos. Madrid predominó en EMERGENCIAS, Cataluña y Andalucía en el SCI y presentaron una producción balanceada Galicia y el País Vasco. La producción científica publicada en EMERGENCIAS presentaba un menor número de originales, fue firmada por menos autores, el urgenciólogo firmó con mayor frecuencia en primer lugar, hubo una mayor frecuencia de urgenciólogos extrahospitalarios y de pertenencia a un servicio de urgencias independiente. Conclusiones: Los urgenciólogos que publican en EMERGENCIAS aportan un volumen similar de trabajos a los que publican en revistas indexadas en el SCI, aunque la mayoría de características bibliométricas y la temática difieren entre ambas (AU)

Aims: To assess the predominant characteristics of scientific papers published by Spanish clinicians from emergency departments physicians, from 2000 to 2004, in journals indexed in the Science Citation Index (SCI) database and in the journal EMERGENCIAS, which is not included in the aforementioned index. Material and method: All the articles published in the journal EMERGENCIAS during the period 2000-2004 were reviewed. A scientific paper was considered a Spanish emergency department physician document if the setting was Spain and if it included any of the following expressions related to an emergency service: urgencias, urgències, urxencias,larrialdiak, larrialdia, emergentziak, emergencias, emergències, emerxencias, emergency, 061, SAMU, 1006, SUC, SEM,SEMSA, SERCAM, 112, DEIAK or EPES. The same strategy was used to search for journals in the SCI during the sameperiod. All data and bibliometric indicators used in previous studies by our group were registered and analyzed. Aslightly modified index of the text “Tratado de Medicina de Urgencias” by Tintinalli was used to determine the lines ofinvestigation. Results: Throughout the whole study period, the Spanish emergency department clinicians published 594 scientific papers; among which 290 appeared in EMERGENCIAS and 304 were indexed in SCI. 51% were written by clinicians from 26 hospitalary emergency departments and 3 emergency systems, in addition to the SEMES. Significant differences were observed in the contribution of each community are centre to the scientific prroduction, the bibliometriccharacteristics and the topics reported between EMERGENCIAS and the SCI. Madrid prevailed in EMERGENCIAS, Cataloniaand Andalusia in the SCI and Galicia and the Basque Country had a balanced scientific production. EMERGENCIAS had a lower number of original studies, signed by fewer authors, emergency department physicians more frequently signed in first place, and frequency of physicians from extrahospitalary emergency departments and independent emergency services was hister. Conclusions: The volume of studies by emergency department physicians pulishing in EMERGENCIAS is similr to that of studies published in journals indexed in the SCI albeit with differences in the bibliometric characteristics and subjects (AU)