Bioactive adrenomedullin as a point-of-care biomarker in emergency department patients with suspected severe infections: an exploratory analysis

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.