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Original Research: COPD |

Stable-State Midrange-Proadrenomedullin Level Is a Strong Predictor of Mortality in Patients With COPDMidrange-Proadrenomedullin in Stable COPD

Maaike C. Zuur-Telgen, MD; Marjolein G. J. Brusse-Keizer, PhD; Paul D. L. P. M. VanderValk, MD, PhD; Job van der Palen, PhD; Huib A. M. Kerstjens, MD, PhD; M. G. Ron Hendrix, MD, PhD
Author and Funding Information

From the Department of Pulmonary Medicine (Drs Zuur-Telgen, Brusse-Keizer, VanderValk, and van der Palen) and the Department of Internal Medicine (Dr Zuur-Telgen), Medisch Spectrum Twente, Enschede; Regional Laboratory of Public Health (Dr Hendrix) and the Department of Research Methodology, Measurement, and Data Analysis (Dr van der Palen), University of Twente, Enschede; the Department of Pulmonary Medicine (Dr Kerstjens) and the Department of Medical Microbiology (Dr Hendrix), University Medical Centre Groningen, University of Groningen, Groningen; and Groningen Research Institute for Asthma and COPD (GRIAC) (Dr Kerstjens), Groningen, The Netherlands.

Correspondence to: Maaike C. Zuur-Telgen, MD, Department of Pulmonary Medicine, Medisch Spectrum Twente, PO Box 50 000, 7500 KA Enschede, The Netherlands; e-mail: maaiketelgen@gmail.com


The abstract of this article was presented at the American Thoracic Society Meeting, May 17-22, 2013, Philadelphia, PA.

Funding/Support: This study was funded by an unrestricted research grant from GlaxoSmithKline for the COMIC (Cohort of Mortality and Inflammation in COPD) cohort.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(3):534-541. doi:10.1378/chest.13-1063
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Background:  Midrange-proadrenomedullin (MR-proADM) has been shown to be elevated in patients hospitalized for an acute exacerbation of COPD (AECOPD) and in patients with community-acquired pneumonia. When measured during AECOPDs, MR-proADM has also been shown to be a predictor of mortality. We hypothesized that MR-proADM levels measured in a stable state could also predict mortality.

Methods:  We included 181 patients in whom we had paired plasma samples for MR-proADM determinations during a stable state and at hospitalization for an AECOPD when they also produced sputum. Time to death or censoring was compared between patients with MR-proADM above or below the median of 0.71 nmol/L. The predictive value of MR-proADM for survival was determined by calculating the C statistic.

Results:  Patients with COPD and MR-proADM levels > 0.71 nmol/L in the stable state had a threefold-higher risk of dying than did patients with MR-proADM levels < 0.71 nmol/L (hazard ratio, 2.98 [95% CI, 1.51-5.90]; C statistic, 0.76). The corrected OR for 1-year mortality was 8.90 (95% CI, 1.94-44.6) in patients with high MR-proADM levels measured in the stable state, compared with patients with low levels measured in the stable state.

Conclusions:  MR-proADM measured in the stable state appeared to be a strong predictor of mortality in patients with COPD. MR-proADM is far easier to measure than other predictors of mortality in COPD, such as BMI, airflow obstruction, dyspnea, and exercise capacity score.

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